Laparoscopic Retropubic Colposuspension The Burch Procedure

Reported in the literature are more than 100 different kinds of surgical treatments for stress urinary incontinence in women, including anterior colporrhaphy (Kelly plication),1 retropubic urethropexy (Marshall-Marchetti-Krantz procedure,2 Burch procedure,2 ), paravaginal suspension,4 various kinds of needle urethropexy,5-8 and suburethral sling procedure.9 Furthermore, among these procedures are many modifications, all of which present a somewhat confusing picture for the practicing surgeon in choosing a proper surgical procedure for incontinent patients. However, with better understanding of the pathophysiology of genuine stress urinary incontinence and with more published data available, there seems to be a consensus, especially among gynecologists that retropubic colposuspension (Burch procedure) is the surgical treatment of choice for genuine stress urinary incontinence in patients who have intact urethral sphincteric mechanism but with poor urethral support and displaced urethrovesical junction.10,11 However, the abdominal Burch procedure requires patients to undergo laparotomy; and the poor visibility of the retropubic space complicates the dissection of space of Retzius and mobilization of the bladder and tends to incur more blood loss. Additional disadvantages include prolonged operating time and increased surgical morbidity. On the other hand, the various kinds of needle urethropexy can be performed easily with a short operating time and hospital stay. However, most reports in the literature indicate that the long term results do not appear to be as effective as retropubic colposuspension.12-15 In our own experience with laparoscopic retropubic colposuspension there has been minimal blood loss, low morbidity and shortened hospital stay and postoperative recovery. This procedure can conveniently be performed with a laparoscopic hysterectomy when the patient presents with both uterine problems and urinary stress incontinence.