The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country.

Saida Abrar,Lubna Razzak,Raheela Mohsin Rizvi

doi:10.12669/pjms.37.5.4017

Saida Abrar, Lubna Razzak + Show 1 more

Open Access

https://doi.org/10.12669/pjms.37.5.4017

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Abstract

Objectives:To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI).Methods:We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6).Results:Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure.Conclusions:All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.

Highlights

International Urogynecological Association (IUGA)[1] defines Stress Urinary Incontinence (SUI) as involuntary loss of urine on effort causing a rise in abdominal pressure
urodynamic studies (UDS) was performed by urodynmicist nurse, before surgery in all cases of Burch colposuspension to rule out intrinsic sphincter deficiency (ISD) while in a few cases of mixed urinary incontinence to exclude neurogenic bladder preoperatively
Our study evaluated 63 patients in transobturator tape (TOT), 59 patients in tension free vaginal tape (TVT) and 40 patients in the Burch colposuspension group

Summary

Introduction

International Urogynecological Association (IUGA)[1] defines SUI as involuntary loss of urine on effort causing a rise in abdominal pressure. It has a severe impact on the quality of life (QOL) of a significant number of women.[2] Among adult women, its prevalence varies from 12.8% to 46.0%.3. Burch colposuspension described in 1961, as a gold standard surgical treatment of SUI in terms of efficacy and safety.[5] Later TVT became the new gold standard, because of being minimally invasive but good success rates.[6] In 2001, Delorme introduced the TOT procedure with the aim to avoid bladder, bowel, and major vascular injuries, reported with other retro-pubic sling techniques.[7]

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