Laparoscopic Burch Urethropexy Research Articles

Is the volume of Burch urethropexy sufficient for urogynecology fellows to meet the ACGME requirement?

Urogynecology fellows report low exposure to nonsling retropubic anti-incontinence procedures such as Burch urethropexy and thus may have difficulty meeting the required minimum case numbers, but there has been an even more objective exploration of this observation. Thus, our objective was to assess the feasibility of meeting the Accreditation Council for Graduate Medical Education (ACGME) requirement for each urogynecology fellow to perform five nonsling retropubic anti-incontinence procedures during fellowship. Cross-sectional study using the National Surgical Quality Improvement Program (NSQIP) and National Resident Matching Program (NRMP) databases from 2009 to 2019. From NSQIP, the number of nonsling retropubic anti-incontinence procedures (open and laparoscopic Burch urethropexy and bladder neck needle suspension) and midurethral sling procedures was extracted using CPT codes. The number of fellows was extracted from the NRMP database. Trends in the number of anti-incontinence procedures were compared with the trend in the number of fellows using linear regression. From 2009 to 2019 the number of fellows doubled from 81 to 176. An average of 97 nonsling retropubic anti-incontinence and 6,372 sling procedures were performed annually. Linear regression showed an increase of 10.7 fellows per year (95% CI 9.3-12.1) versus an increase of 5.8 nonsling retropubic anti-incontinence procedures per year (95% CI -0.4 to 12.1). This contrasts with an increase of 690.9 slings per year (95% CI 509.9-872.0). The increase in the number of nonsling retropubic anti-incontinence procedures does not appear to match the increase in the number of urogynecology fellows. Supplementary educational approaches such as simulation may be prudent.

Concomitant Laparoscopic Burch Urethropexy and Combined Vaginal-Laparoscopic Mesh Sling Removal (x2) for Pain and Persistent Stress Urinary Incontinence.

Although midurethral mesh tape slings are considered the standard of care in the treatment of female stress urinary incontinence (SUI), complications such as pain, dyspareunia, or erosion are known to occur in addition to persistent incontinence. The management of these types of mesh sling complications can be very complex, especially when the pain is not just isolated to the vagina but extends into other areas, such as the abdomen which requires a much more extensive dissection. Additionally, if a mesh sling needs to be removed, the patient will most likely have a return of her SUI that often necessitates subsequent treatment. Vaginal and/or laparoscopic removal or revision of mesh tape slings should be considered in patients presenting with complications such as vaginal pain, abdominal pain, dyspareunia, or urinary obstructive symptoms. In those patients who demonstrate persistent SUI, concomitant laparoscopic Burch urethropexy can be considered and can safely be performed at the time mesh removal. In this case report we present a patient who required a dual-approach removal of two painful midurethral slings in addition to concomitant treatment of persistent SUI with a laparoscopic Burch urethropexy procedure.

Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

Outcomes Following Combined Laparoscopic Burch Urethropexy at Time of Mesh Sling Removal: A Prospective Cohort Study.

Outcomes Following Combined Laparoscopic Burch Urethropexy at Time of Mesh Sling Removal: A Prospective Cohort Study.

Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique

The objective of this article was to review the available literature on laparoscopic Burch urethropexy cure rates and describe the authors' laparoscopic technique and experience with Burch urethropexy and paravaginal repair. A MEDLINE search (1991 to 1999) was performed for articles describing the laparoscopic Burch urethropexy using suture to elevate and stabilize the paraurethral tissue. Also a retrospective chart review of the authors' 171 consecutive patients between January 1997 and December 1999 was done. The laparoscopic Burch urethropexy and paravaginal repair is described using an open laparoscopic technique with 3 accessory ports for access. A transperitoneal approach is taken to gain access to the space of Retzius. The anterior vaginal wall and its paravaginal defects, if present, are identified. Nonabsorbable sutures are placed in a conventional fashion. The paravaginal repair is used for support of the anterior vaginal wall proximal to the urethral vesical junction and the Burch urethropexy distal to the vesical neck. An average of 6 sutures are used for the paravaginal repair and 4 sutures for the Burch urethropexy. Cystoscopy is performed to ensure no breech of lower urinary tract integrity. In all, 20 articles describing a laparoscopic Burch urethropexy and postoperative cure rate were identified. Cure rates ranged from 69% to 100%. A review of our experience revealed 130 of 171 patients had a Burch urethropexy and paravaginal repair, 23 of 171 patients a Burch urethropexy alone, and 18 of 171 patients a paravaginal repair alone. Of the authors' 171 patients, 4 (2.3%) had injury to the lower urinary tract during laparoscopic Burch urethropexy or paravaginal repair. All 4 injuries were cystotomies, 2 in patients with previous open retropubic urethropexies. No ureteral ligations or intravesical placement of suture was diagnosed. Other surgical parameters for the laparoscopic Burch uethropexy and paravaginal repair include an estimated blood loss of 50 mL, average hospital stay of less than 23 hours, and an average operative time of 70 minutes. All patients had their surgery completed via laparoscopy. The literature review and our personal experience suggests that the laparoscopic Burch urethropexy and paravaginal repair are safe and effective alternatives to traditional laparotomy for the treatment of genuine anatomic stress urine incontinence and cystourethrocele resulting from lateral vaginal wall defects.

Frequency of Lower Urinary Tract Injury at Laparoscopic Burch and Paravaginal Repair

To estimate the rate of injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair. Retrospective analysis over 30 consecutive months (Canadian Task Force classification II-2). Setting. Community hospital. One hundred seventy-one consecutive patients. Laparoscopic Burch urethropexy and/or paravaginal repair. All patients had intraoperative transurethral videocystoscopy performed with intravenous injection of indigo carmine dye to assess potential injury to bladder or ureter. Four women (2.3%, CI -0.71-0.03) had injury to the lower urinary tract. All four injuries were cystotomies, two in women with previous open retropubic urethropexy. No ureteral ligation or intravesical placement of suture was diagnosed. Despite most patients having both Burch urethropexy and paravaginal repair, the lower urinary tract injury rate of 2.3% is much lower than the reported 10% for patients having Burch urethropexy alone performed by laparotomy. Reported benefits of laparoscopy including less blood loss and better visualization may explain this result.

Laparoscopic burch and paravaginal repair and incidence of lower urinary tract injury

Abstract Objective: This study was undertaken to determine the rate of injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair. Methods: The charts of 159 consecutive patients from January 1997 to July 1999 who underwent laparoscopic Burch and/or paravaginal repair were reviewed. All patients had intraoperative transurethral video cystoscopy performed with intravenous injection of indigo carmine dye to assess potential injury to the bladder or ureter. Results: Lower urinary tract injury was diagnosed in 4 of 159 (2.5%) patients having laparoscopic Burch and/or paravaginal repair. All 4 injuries were cystotomies with 3 occurring during Burch urethropexy and 1 during a paravaginal repair. Two of these patients had previous open retropubic urethropexies (1 MMK and 1 prolene mesh urethropexy). No ureteral ligations or intravesical suture placement were diagnosed. No statistical differences in demographics or surgical parameters were found when comparing patients with and without injuries. Conclusions: Despite most patients in this study having both Burch urethropexy and paravaginal repair, the lower urinary tract injury rate of 2.5% is much lower than the reported injury rate of 10% for patients who have Burch urethropexy alone performed via laparotomy. The reported benefits of laparoscopy, including less blood loss and better visualization may explain the lower incidence of injury. The authors believe the laparoscopic approach, performed by experienced surgeons, may reduce lower urinary tract injury during anterior vaginal wall reconstruction.

Laparoscopic burch urethropexy in a private clinical practice

To determine the effectiveness of laparoscopic Burch urethropexy in a private practice setting. Prospective, observational study (Canadian Task Force classification II-2). Private practice. Fifty-one consecutive women with stress urinary incontinence (15 genuine stress urinary incontinence, 36 concomitant degrees of pelvic organ prolapse). Laparoscopic Burch urethropexy was performed with sutures in 36 patients and with mesh and staples in 15, in combination with laparoscopic vaginal vault suspension, paravaginal repair, laparoscopic-assisted vaginal hysterectomy, and other procedures. Intraoperative complications occurred in 10% of cases; all were recognized and repaired laparoscopically. Operating time ranged from 55 minutes to 3 hours (median 2 hrs 25 min). Forty-four (86%) surgeries were done on an outpatient basis, five women required an overnight stay, and two were admitted. Forty-seven (93%) patients were discharged without a catheter; two had urinary retention requiring a catheter for 5 days. Follow-up ranged from 12 to 42 months (average 24 mo). Forty-eight women (94%) were cured, three (6%) failed therapy, and six (12%) developed de novo detrusor instability. Burch urethropexy can be performed safely by laparoscopy in a private practice setting with success similar to that of open technique. Most intraoperative complications can be corrected laparoscopically with no increase in morbidity. (J Am Assoc Gynecol Laparosc 6(1):39-44, 1999)

Long-term results of laparoscopic burch urethropexy

To evaluate the long-term efficacy of laparoscopic Burch urethropexy. Pilot study. Private practice. Thirty-five consecutive women (average age 45.5 yrs, average parity 2.3, average weight 67.7 kg) treated for genuine stress incontinence between May 1992 and July 1994. Urethropexy was performed with curved needle suturing in 7 women, straight needle suturing in 5, and Stamey needle suturing in 23. Twenty-five (71.4%) patients had concomitant pelvic surgery. Wilcoxon two-sample, chi2, and Fisher's exact tests were performed to determine which variables were significantly associated with surgical success. Average operating time was 190 minutes, hospitalization 24 hours, and catheterization 5 days. The cure rate of stress incontinence was 89% 3 months and 86% 1 year after surgery. At average follow-up of 34 months, only 68.6% of patients reported complete or almost complete cure, 11.4% were improved, and 20% were complete failures. The only operative variable approaching statistical significance for predicting surgical success was type of suture needle (p = 0.07), with the Stamey needle group having the highest cure rate. Women who were cured or almost cured had a significantly shorter follow-up than those who were improved or failures (p = 0.001). The success rate of laparoscopic Burch urethropexy compares with that of open Burch procedure at 1 year, but drops considerably thereafter.

Long-term results of laparoscopic Burch urethropexy

We evaluated the long-term efficacy of laparoscopic Burch urethropexy performed in 35 consecutive women (average age 45.5 yrs, average weight 67.7 kg, average parity 2.3) between May 1992 and July 1994. Preoperative evaluations included cotton swab testing, urinalysis, dynamic urethrocystoscopy, and multichannel urodynamic testing. All subjects had genuine stress incontinence and a positive cotton swab test. Urethropexy was performed with curved needle suturing in 7 women, straight needle suturing in 5, and Stamey needle suturing in 23. Outcome variables were operative time, concomitant surgery, suture needle, length of hospital stay, need for catheterization, and subjective success. Women were divided into groups based on surgical success. Wilcoxon two-sample, chi2, and Fisher's exact tests were used to determine which variables were significantly associated with surgical success. Twenty-five women (71.4%) had concomitant pelvic surgery at the time of urethropexy. Average time of surgery was 190 minutes, length of stay 1 day, and length of time for catheterization 5 days. The cure rate of stress incontinence was 89% at 3 months and 86% at 1 year. At an average follow-up of 30 months, only 68.6% of women reported complete or almost complete cure, 11.4% were improved, and 20% were complete failures. The only variable approaching statistical significance for predicting surgical success was type of suture needle used (p = 0.07), with the Stamey needle group having the highest cure rate. The success rate of laparoscopic Burch urethropexy compares with that of open Burch procedure at 1 year but drops considerably thereafter.

Laparoscopic burch repair compared to laparotomy Burch for cure of urinary stress incontinence

Sixty-two women underwent either laparoscopic Burch urethropexy or open Burch urethropexy for surgical correction of genuine stress urinary incontinence. Only patients with no prior incontinence surgery and with demonstrated genuine stress incontinence were included. Clinical evaluations were done preoperatively, at 3 months and 1 year postoperatively for objective cure. The preoperative evaluation included a 24-hour urolog, urology questionnaire, Q-tip test, cough stress test, perineal ultrasound, cystourethroscopy and simple-channel cystometrics. At follow-up all patients had repeat Q-tip test, perineal ultrasound and cough stress test. If there was any sign of leaking a repeat single-channel cystometrogram was done. Only patients with a negative objective study were considered cured. Differences in laparoscopic versus laparotomy cure rates at 1 year were insignificant (94% versus 93%). Both procedures stabilized the urethrovesical junction and prevented its descent during straining, as demonstrated by the postoperative Q-tip test and the perineal ultrasound. The two bladder procedures had comparable operative times but patients with laparoscopy voided earlier, were outpatients, and returned to work earlier. In conclusion, short-term results suggest that the laparoscopic Burch urethropexy can give similar results to laparotomy Burch urethropexy for correction of genuine stress incontinence.

Laparoscopic versus preperitoneal burch urethropexy—Comparative outcomes after one year

Laparoscopic versus preperitoneal burch urethropexy—Comparative outcomes after one year

Comparison of laparoscopic and open retropubic urethropexy for treatment of stress urinary incontinence

Laparoscopic retropubic urethropexy has recently been described as an alternative method to the surgical correction of pure stress urinary incontinence. This study compares the operative technique and results of laparoscopic colposuspension with traditional open Burch urethropexy to treat women with stress urinary incontinence. We assessed the short-term results of 12 women who underwent a modified laparoscopic Burch urethropexy for the correction of stress urinary incontinence and compared these with a similar contemporary group of 10 women who underwent a traditional open Burch colposuspension procedure. Ten women (83%) who underwent the laparoscopic procedure are continent with a mean follow-up of 20.8 months, and 7 women (70%) who had an open Burch colposuspension are continent at a mean follow-up of 35.6 months. The laparoscopic procedure took an average of 1.5 hours longer than the open repair (P < 0.01). Patients who underwent the laparoscopic urethropexy required less postoperative analgesia (mean, 14.2 mg morphine equivalents versus 131.4 mg; P < 0.01), shorter length of hospitalization (mean, 1.9 days versus 4.9 days; P < 0.01), and a more expedient return to normal activity when compared with those who underwent open Burch colposuspension. Laparoscopic bladder neck suspension offers a less invasive approach to the surgical correction of stress urinary incontinence and can provide successful outcomes in properly selected patients.