The contemporary role of Burch colposuspension

Abstract

The purpose of this review was to define the current role of Burch colposuspension for treatment of female stress urinary incontinence. Publications from 2004 were reviewed. The open Burch colposuspension is reviewed with highlights on its efficacy, mechanism of continence, recent reports on intraoperative ultrasound, postoperative catheterization, coital incontinence, and the effect of concomitant procedures. Long-term efficacy has remained at approximately 70%. Less invasive Burch approaches are evaluated including the laparoscopic techniques and the mini-incisional Burch colposuspension. The laparoscopic Burch approach is satisfactory if sutures rather than mesh are used. Three well designed, prospective, randomized trials comparing the Burch (one open and two laparoscopic) colposuspension with tension-free vaginal tape are discussed. The open Burch procedure with its long-term success rates remains a gold standard for surgical treatment of genuine stress urinary incontinence. Less invasive Burch procedures require longer term follow-up studies with comparison to the open approach and tension-free vaginal tape before its role can be settled. At this point, tension-free vaginal tape appears to be at least equivalent to the Burch colposuspension and, with longer follow-up studies, may challenge its role as a gold standard surgical treatment for female stress incontinence.