Abstract

Introduction: The International Continence Society (ICS) defined stress urinary incontinence as

“involuntary leakage on effort or exertion, or on sneezing or coughing”. Urinary incontinence occurs

frequently, and affects the life quality of millions of people all around the world. The prevalence of

incontinence in women is reported between 4.5% and 53%. Various factors have been shown to be associated

with an increased prevalence of urinary incontinence, for example over-weight, gynecological operations,

chronic respiratory illness, obstipation, jobs involving heavy lifting and physical exercise, and parity. A wide

variety of surgical techniques have been devised for the treatment of stress urinary incontinence. Mechanism

of these procedures is providing suburethral support or stabilizing the urethra. However, only the Burch

colposuspension and autologous fascial pubovaginal sling have sufficient studies which have been documented

long-term efficacy. Success rates are extremely well in short-term follow up, however these rates are gradually

decreasing with longer follow-up. We aimed to review long-term results with the Burch colpocystourethropexy

which were performed in our clinic.

Materials and Methods: A total of 67 patients who underwent Burch colposuspension were studied

retrospectively from a group of 98 patients who underwent anti-stress incontinence procedure between

January 1992 and January 2001 in our clinic. Fifty-seven (85.1%) patients were included in this study.

Preoperative investigation consisted of detailed medical history, physical examination, 1 hour pad test, Q-type

test, and cystourethroscopy in some patients. Additionally, cystometric studies were performed on 53 (79.1%)

patients with 6 channel urodynamic equipment. The patients were operated with modified Burch

colpocystourethropexy technique as described by Tanagho. Postoperatively, patients were investigated for

lower urinary tract symptoms and incontinence in face-to-face interviews and were also assessed by 1 hour

pad test and physical examination.

Results: Patients’ mean age was 50.8±11.9 years. The mean follow-up was 5.7±3.4 years. Preoperatively,

22 of the cases (38.6%) had 1st degree and 13 had (22.8%) 2nd degree cyctocele. Besides, 1st degree rectocele

was observed in 10 cases (17.5%) and 2nd degree in 8 cases (14.0). Idiopathic detrusor overactivity was detected

in 10 of 53 patients and cystometry was performed before the operation. Additionally, eight patients (14%)

had had failed anti stress urinary incontinence surgery in medical history. The average of pad test was

11.0±1.1 g and 2.6±0.6 g (p<0.0001) in preoperative and postoperative patients, respectively. Forty-one (71.9%)

patients were considered as cured, 4 (7%) significantly improved (partial responders), 8 (14%) failures, and 4

(7%) had urge incontinence. One of the urge incontinent cases occurred de-novo and the others were observed

as continuation of preoperative complaints. However, two of these patients were operated before urodynamics.

Only one case (1.8%) that could not void in early postoperative period was treated by transurethral catheter

for three weeks and no complication was observed later.

Conclusion: More than two thirds of our patients who underwent a Burch colposuspension had a

favorable long-term outcome. The evidence available indicates that open retropubic colposuspension is the

most effective treatment modality for stress urinary incontinence especially in the long term. Additionally, this

procedure has higher success rates and is more cost-effective than other procedures in our country. For these

reasons, Burch colposuspension maintains its reliability as a safe procedure.