Burch Colposuspension is an effective operation for the treatment of stress incontinence with long-term objective cure rates exceeding 80% (1). Laparoscopic Burch Colposuspension was described in 1990 and has gained wide popularity in recent years (2,3). With the exception of two small series the introduction of this procedure has proceeded without appropriate randomised controlled trials (4,5). The aims of this study were to evaluate the short-term benefits and long-term success of the Laparoscopic Burch (LB) compared to the Open Burch (OB) Colposuspension.

Methods:

This study was performed at nine hospitals by six surgeons of different expertise levels. The two senior authors together performed 70 Laparoscopic Colposuspensions before commencing the study. Two-hundred consecutive women with urodynamic evidence of genuine stress incontinence and no previous history of retropubic surgery were prospectively recruited. All women were randomised to either conventional OB or LB.  The surgeon was unaware of which procedure was to be performed until surgery. Abdominal wounds were dressed in theatre in an identical fashion so that both patients and ward-staff were blinded to the procedure performed until removal of dressings prior to discharge. Details including duration of surgery, intra-operative blood loss, visual assessment scores for post-operative pain, voiding difficulties and duration of stay were recorded.  Urinary continence scores, symptom questionnaire, urodynamics, evaluation of urogenital prolapse and quality of life (QOL) assessment using the SF36, SUDI and SIIQ were performed pre-operatively and 6 months post-operatively. Return to normal activities was assessed at the six-week follow-up visit. Subjective and objective cure rates were determined using continence scores, visual analogue scores and urodynamics. A cost analysis was performed for both the OB and LB procedures.

Results: 

There were 96 women in the LB and 104 in the OB groups.  There were no significant differences in the preoperative demographics and the subjective and objective outcomes  at six months for both the OB and LB groups were comparable (Table 1). Significant improvement in QOL was observed following both procedures at six months. There was one bladder perforation in the OB requiring blood transfusion and five in the LB group. In the LB group the perforating suture was removed and resited in three cases and the remaining two were converted to OB. In all of these cases a catheter was left in-situ for five days. In one LB case laceration to the obturator vein occurred and was repaired laparoscopically. There were no other significant intra-operative complications.