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Randomized Controlled Trial
. 2008 Jul;112(1):49-55.
doi: 10.1097/AOG.0b013e3181778d2a.

Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence

Linda Brubaker  1 , Ingrid Nygaard, Holly E Richter, Anthony Visco, Anne M Weber, Geoffrey W Cundiff, Paul Fine, Chiara Ghetti, Morton B Brown
Affiliations
Randomized Controlled Trial

Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence

Linda Brubaker et al. Obstet Gynecol. 2008 Jul.

Erratum in

Abstract

Objectives: To report anatomic and functional outcomes 2 years after sacrocolpopexy in stress-continent women with or without prophylactic Burch colposuspension.

Methods: In the Colpopexy and Urinary Reduction Efforts (CARE) trial, stress-continent women undergoing sacrocolpopexy were randomized to receive or not receive a Burch colposuspension. Outcomes included urinary symptoms, other pelvic symptoms, and pelvic support. Standardized pelvic organ prolapse quantification examinations and validated outcome measures including the Pelvic Floor Distress Inventory and the Pelvic Floor Impact Questionnaire were completed before surgery and at several postoperative intervals, including at 2 years.

Results: This analysis is based on 322 randomized participants; certain analyses were done with a subset based on data availability. Most were Caucasian (94%), with a mean age of 62±10 years (mean±standard deviation). Two years after surgery, 41.8% and 57.9% of women in the Burch and control groups, respectively, met the stress incontinence endpoint (presence of symptoms or positive cough stress test or interval treatment for stress incontinence, P=.020). The apex was well supported (point C within 2 cm of total vaginal length) in 95% of women, and this was not affected by concomitant Burch (P=.18). There was a trend toward fewer urgency symptoms in the Burch group (32.0% versus 44.5% no Burch, P=.085). Twenty participants experienced mesh or suture erosions.

Conclusion: The early advantage of prophylactic Burch colposuspension for stress incontinence that was seen at 3 months remains at 2 years. Apical anatomic success rates are high and not affected by concomitant Burch.

Clinical trial registration: (www.clinicaltrials.gov), ClinicalTrials.gov, NCT00065845.

Level of evidence: I.

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References

    1. Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354:1557–66. - PubMed
    1. Burgio KL, Nygaard IE, Richter HE, Brubaker L, Gutman RE, Leng W, et al. for the Pelvic Floor Disorders Network. Bladder symptoms one year after abdominal sacrocolpopexy with and without Burch colposuspension in women without preoperative stress incontinence symptoms. Am J Obstet Gynecol. 2007;197:647, e1–e6. - PubMed
    1. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356:2143–55. - PubMed
    1. Brubaker L, Cundiff G, Fine P, Nygaard I, Richter H, Visco A, et al. A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods. Control Clin Trials. 2003;24:629–42. - PubMed
    1. Diokno AC, Brock BM, Brown MB, Herzog AR. Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol. 1986;136:1022–5. - PubMed

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