Open retropubic colposuspension for urinary incontinence in women
- PMID: 28741303
- PMCID: PMC6483458
- DOI: 10.1002/14651858.CD002912.pub7
Open retropubic colposuspension for urinary incontinence in women
Abstract
Background: Urinary incontinence is a common and potentially debilitating problem. Stress urinary, incontinence as the most common type of incontinence, imposes significant health and economic burdens on society and the women affected. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure to correct stress urinary incontinence.
Objectives: The review aimed to determine the effects of open retropubic colposuspension for the treatment of urinary incontinence in women. A secondary aim was to assess the safety of open retropubic colposuspension in terms of adverse events caused by the procedure.
Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 5 May 2015), and the reference lists of relevant articles. We contacted investigators to locate extra studies.
Selection criteria: Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group.
Data collection and analysis: Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated.
Main results: This review included 55 trials involving a total of 5417 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.46; 95% CI 0.30 to 0.72 before the first year, RR 0.37; 95% CI 0.27 to 0.51 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 22 trials in comparison with suburethral slings (traditional slings or trans-vaginal tape or transobturator tape) found no overall significant difference in incontinence rates in all time periods evaluated (as assessed subjectively RR 0.90; 95% CI 0.69 to 1.18, within one year of treatment, RR 1.18; 95%CI 1.01 to 1.39 between one and five years, RR 1.11; 95% CI 0.97 to 1.27 at five years and more, and as assessed objectively RR 1.24; 95% CI 0.93 to 1.67 within one year of treatment, RR 1.12; 95% CI 0.82 to 1.54 for one to five years follow up, RR 0.70; 95% CI 0.30 to 1.64 at more than five years). However, subgroup analysis of studies comparing traditional slings and open colposuspension showed better effectiveness with traditional slings in the medium and long term (RR 1.35; 95% CI 1.11 to 1.64 from one to five years follow up, RR 1.19; 95% CI 1.03 to 1.37).In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.56; 95% CI 0.39 to 0.81), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Voiding problems are also more common after sling procedures compared to open colposuspension.
Authors' conclusions: Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterior colporrhaphy, but with a lower risk of voiding dysfunction compared to traditional sling surgery. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not yet known. A Brief Economic Commentary (BEC) identified five studies suggesting that tension-free vaginal tape (TVT) and laparoscopic colposuspension may be more cost-effective compared with open retropubic colposuspension.
Conflict of interest statement
Marie Carmela Lapitan: none known June Cody: none known Atefeh Mashayekhi: This project, to add Brief Economic Commentaries to our 'Surgery for UI in women' reviews, was supported by the National Institute for Health Research (NIHR), via the Cochrane Review Incentive Scheme 2016, to the Cochrane Incontinence Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
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Update of
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Open retropubic colposuspension for urinary incontinence in women.Cochrane Database Syst Rev. 2016 Feb 15;2:CD002912. doi: 10.1002/14651858.CD002912.pub6. Cochrane Database Syst Rev. 2016. Update in: Cochrane Database Syst Rev. 2017 Jul 25;7:CD002912. doi: 10.1002/14651858.CD002912.pub7. PMID: 26878400 Updated.
References
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- Mundy AR. A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress incontinence. British Journal of Urology 1983;55(6):687‐90. [sr‐incont672] - PubMed
O'Sullivan 2000 {published data only}
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- O'Sullivan S, Avery N, Balley A, Keane D. The effect of surgery on the collagen metabolism of paraurethral tissue in women with genuine stress incontinence (Abstract O10). International Urogynaecology Journal 2000;11 Suppl 1:S5. [sr‐incont11903]
Osman 2003 {published data only}
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- Osman T. Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. BJU International 2003;92(9):964‐8. [sr‐incont16660] - PubMed
Palma 1985 {published data only}
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- Palma P, David S, Pinotti JA. Comparative study between the Marshall‐Marchetti‐Krantz operation and the endoscopic suspension of the bladder neck for surgical correction of stress urinary incontinence (Abstract). Archives of Gynecology 1985;237 Suppl:402. [sr‐incont9864]
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- Palma PC, Soffiatti SA, Almeida SC, Pinotti JA. Stress urinary incontinence: a comparative study of surgical treatment by the Marshall‐Marchetti‐Krantz technique with endoscopic suspension of the bladder neck. Second report. Asia Oceania Journal of Obstetrics and Gynaecology 1988;14(1):31‐6. [sr‐incont15461] - PubMed
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- Palma PCR, Suely A, Soffiatti D, Pinotti JA. Stress urinary incontinence: a comparative study of the surgical treatment by the Marshall‐Marchetti‐Krantz technique with endoscopic suspension of the bladder neck. Second report. Ginecologia and Obstetricia (Sociedad Peruana de Obstetricia y Ginecologia) 1986;30(2):15‐9. [sr‐incont15464]
Quadri 1985 {published data only}
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- Colombo M, Scalambrino S, Gallazzi S, Milani R. Burch colposuspension versus anterior repair in severe genital prolapse with stress incontinence: long term follow‐up (Abstract number 174). Proceedings of the International Continence Society, 23rd Annual Meeting, 1993 Sep 8‐11, Rome, Italy. 1993:440‐2. [sr‐incont12045]
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- Milani R, Scalambrino S, Vicandone G, Sirtori P, Spazzini D. Complementary drug therapy improving results of surgery for incontinence and prolapse into two randomized procedures: vaginal versus suprapubic operation (Abstract). Proceedings of the International Continence Society (ICS), 14th Annual Meeting, Sept, Innsbruck, Austria. 1984:440‐1. [sr‐incont9867]
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- Quadri G, Scalambrino S, Boisio N, Marchesin R, Milani R. Randomized surgery for incontinence and prolapse: Retropubic colposuspension vs anterior repair (Abstract). Archives of Gynecology 1985;237 Suppl:402. [sr‐incont8019]
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- Scalambrino S, Biosio N, Marchesin R, Quadri G, Alegri M, Milani R. Clinical and urodynamic results in a surgical trial for incontinence and prolapse (Abstract). Proceedings of the International Continence Society (ICS), 15th Annual Meeting, 3‐6 Sept, London, UK. 1985:484‐5. [sr‐incont9865]
Quadri 1999 {published data only}
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- Quadri G, Magatti F, Belloni C, Barisani D, Natale N. Marshall‐Marchetti‐Krantz urethropexy and Burch colposuspension for stress urinary incontinence in women with low pressure and hypermobility of the urethra: early results of a prospective randomized clinical trial. American Journal of Obstetrics and Gynecology 1999;181(1):12‐8. [sr‐incont8864] - PubMed
Sand 2000 {published data only}
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- Culligan PJ, Goldberg RP, Sand PK. A randomized controlled trial comparing a modified Burch procedure and a suburethral sling: long‐term follow‐up. International Urogynecology Journal 2003;14(4):229‐33. [sr‐incont16706] - PubMed
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- Culligan PJ, Winkler HA, Blackhurst DW, Sand PK. A prospective randomized study of modified Burch retropubic urethropexy and suburethral sling for genuine stress incontinence and low pressure urethra. Proceedings of the International Continence Society (ICS), 28th Annual Meeting, 1998 Sep 14‐17, Jerusalem, Israel. 1998:133. [sr‐incont5689]
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- Goldberg RP, Culligan PJ, Koduri S, Sand PK. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling: long term follow‐up (Abstract). International Urogynaecology Journal 2000;11(Suppl 1):S8. [sr‐incont11904]
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- Goldberg RP, Sand PK, Koduri S, Culligan PJ. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling: long term follow‐up (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 2001;12(Suppl 1):S6. [sr‐incont12004]
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- Sand PK, Winkler H, Blackhurst DW, Culligan PJ. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling for treatment of genuine stress incontinence with low‐pressure urethra. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 1):30‐4. [sr‐incont9013] - PubMed
Sivaslioglu 2007 {published data only}
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- Sivaslioglu AA, Caliskan E, Dolen I, Haberal A. A randomized comparison of transobturator tape and Burch colposuspension in the treatment of female stress urinary incontinence. International Urogynecology Journal 2007;18(9):1015‐9. [sr‐incont23854] - PubMed
Stangel‐Wojcikiewicz 2008 {published data only}
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- Stangel‐Wojcikiewicz K. Laparoscopic Burch colposuspension compared to laparotomy for treatment urinary stress incontinence (Abstract number 121). Neurourology and Urodynamics 2008;27(7):714. [sr‐incont31857]
Su 1997 {published data only}
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- Su TH, Wang KG, Hsu CY, Wei HJ, Hong BK. Prospective comparison of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence. Acta Obstetricia et Gynecologica Scandinavica 1997;76:576‐82. [sr‐incont5558] - PubMed
Summitt 2000 {published data only}
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- Summitt RL, Lucente V, Karram MM, Shull BL, Bent AE. Randomized comparison of laparoscopic and transabdominal Burch urethropexy for the treatment of genuine stress incontinence (Abstract). Obstetrics and Gynecology 2000;95(4):S2. [sr‐incont11862]
Tapp 1989 {published data only}
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- Tapp AJS, Hills B, Cardozo L. Pelvic floor physiotherapy compared with the Burch colposuspension in the treatment of genuine stress incontinence. Proceedings of the Silver Jubilee British Congress of Obstetrics and Gynaecology. 1989:65. [sr‐incont8015]
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- Tapp AJS, Hills B, Cardozo L, Tapp AJ. Randomised study comparing pelvic floor physiotherapy with the Burch colposuspension. Neurourology and Urodynamics 1989;8:356‐7. [sr‐incont4515]
Tellez Martinez‐Fornes 2009 {published data only}
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- Tellez Martinez‐Fornes M. A Three Year Follow‐up Prospective Open Randomized Trial of Tension‐Free Vaginal Tape and Colposuspension for Primary Urodynamic Stress Incontinence. http://clinicaltrials.gov/show/NCT00782990 (accessed 5 May 2015) 2001. [sr‐incont62910]
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- Tellez Martinez‐Fornes M, Fernandez Perez C, Fouz Lopez C, Fernandez Lucas C, Borrego Hernando J. A three year follow‐up of a prospective open randomized trial to compare tension‐free vaginal tape with Burch colposuspension for treatment of female stress urinary incontinence. Actas Urologicas Espanolas 2009;33(10):1088‐96. [sr‐incont39608] - PubMed
Trabuco 2014 {published data only}
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- Trabuco E, Klingele C, Blandon R, Occhino J, McGree M, Weaver A, et al. A randomized comparison of incontinence procedures performed concomitantly with abdominal sacrocolpopexy: the Burch versus mid‐urethral sling trial (Abstract number 689). Neurourology and Urodynamics 2014;33(6):1005. [NCT00934999; sr‐incont64705]
Tuygun 2006 {published data only}
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- Tuygun C, Bakirtas H, Eroglu M, Alisir I, Zengin K, Imamoglu A. Comparison of two different surgical approaches in the treatment of stress urinary incontinence: Open and laparoscopic Burch colposuspension. Turk Uroloji Dergisi 2006;32(2):248‐53. [sr‐incont26724]
Ustun 2005 {published data only}
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- Ustun Y, Engin‐Ustun Y, Gungor M, Tezcan S. Randomized comparison of Burch urethropexy procedures concomitant with gynecologic operations. Gynecologic and Obstetric Investigation 2005;59(1):19‐23. [sr‐incont20187] - PubMed
Wang 2003 {published data only}
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- Wang AC, Chen MC. Comparison of tension‐free vaginal taping versus modified Burch colposuspension on urethral obstruction: a randomized controlled trial. Neurourology and Urodynamics 2003;22(3):185‐90. [sr‐incont16021] - PubMed
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- Wang AC, Liang CC, Lo TS, Tseng LH. Does tension‐free vaginal tape procedure really exert no tension on the urethra? ‐ A randomized controlled study using the voiding mechanism (Abstract). International Urogynecology Journal 2001;12(Suppl 3):S111. [sr‐incont15459]
Ward 2002 {published and unpublished data}
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- Abrams P, Martin K, Bulmer P, Donovan J, Hilton P. Responsiveness of the Bristol female lower urinary tract symptoms questionnaire (BFLUTS‐Q) to surgical intervention in a randomised controlled trial (Abstract). Proceedings of the International Continence Society (ICS), 30th Annual Meeting, 28‐31 Aug, Tampere, Finland. 2000:A173. [sr‐incont9954]
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- Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P. A scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. American Journal of Obstetrics and Gynecology 2004;191(1):73‐82. [sr‐incont19277] - PubMed
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- Manca A, Sculpher MJ, Ward K, Hilton P. A cost‐utility analysis of tension‐free vaginal tape (TVT) versus colposuspension for primary genuine stress incontinence (unpublished material). Personal communication 2002. [sr‐incont12892]
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- Manca A, Sculpher MJ, Ward K, Hilton P. A cost‐utility analysis of tension‐free vaginal tape versus colposuspension for primary urodynamic stress incontinence. BJOG: an International Journal of Obstetrics and Gynaecology 2003;110:255‐62. [sr‐incont14361] - PubMed
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- Sculpher MJ, Ward KL, Hilton P. A comparison of the hospital cost of tension‐free vaginal tape and colposuspension (Abstract). Proceedings of the International Continence Society (ICS), 30th Annual Meeting, 28‐31 Aug, Tampere, Finland. 2000:333‐4. [sr‐incont9871]
References to studies excluded from this review
Adile 2001 {published data only}
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- Adile B, Liguori P, Pisapia G, Alvino G, Bova C. Tension‐free vaginal tape for surgical treatment of stress urinary incontinence. An Italian multicenter study and two year follow‐up. [Italian]. Urogynaecologia International Journal 2001;15(Suppl 1):68.
Adile 2001b {published data only}
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- Adile B, Cucinella G, Gugliotta G, Lo BA, Grifo S, Caputo A. A prospective randomized study on Burch laparoscopy versus tension‐free vaginal tape: 2 year follow‐up. [Italian]. Urogynaecologia International Journal 2001;15(Suppl 1):121‐2.
Ankardal 2007 {published data only}
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Brubaker 2009 {published data only}
Bump 1988 {published data only}
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Bump 1996 {published data only}
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- Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF, et al. Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group. American Journal of Obstetrics and Gynecology 1996;175(2):326‐35. - PubMed
Byrne 1989 {published data only}
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- Byrne P, Condie R, Shafi M. A comparison of the Burch colposuspension and Aldridge sling operation for the treatment of stress incontinence (Abstract). Proceedings of the International Continence Society (ICS), Louvain, Belgium. 1989.
Colombo 1997 {published data only}
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- Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R. Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension. American Journal of Obstetrics and Gynecology 1997;176(2):337‐43. - PubMed
Cornish 2001 {published data only}
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Costantini 2007a {published data only}
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Costantini 2007b {published data only}
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- Costantini E, Lazzeri M, Bini V, Zingaro M, Frumenzio E, Porena M. Pelvic organ prolapse repair with and without concomitant Burch colposuspension in incontinent women: a randomised controlled trial with at least 5‐year followup. Obstetrics and Gynecology International 2012;2012:Article ID 967923. - PMC - PubMed
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- Costantini E, Lazzeri M, Giannantoni A, Zingaro M, Fioretti F, Zucchi A, et al. Abdominal integral pelvic reconstruction plus or minus Burch colposuspension in the treatment of severe uro‐genital prolapse associated to urinary incontinence. A RCT with a mid‐term follow‐up (Abstract number 476). 37th Annual Meeting of the International Continence Soceity (ICS), 20‐24 Aug 2007, Rotterdam, Netherlands. 2007. [sr‐incont23534]
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- Costantini E, Lazzeri M, Giannantoni A, Zingaro M, Fioretti F, Zucchi A, et al. Abdominal integral pelvic reconstruction plus or minus Burch colposuspension in the treatment of severe uro‐genital prolapse associated to urinary incontinence. A RCT with a mid‐term follow‐up (Abstract number 476). Proceedings of the 37th Annual Meeting of the International Continence Soceity (ICS), 20‐24 Aug 2007, Rotterdam, Netherlands. 2007.
Costantini 2008 {published data only}
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- Costantini E, Lazzeri M, Bini V, Zingaro M, Zucchi A, Porena M. Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. Journal of Urology 2008;180(3):1007‐12. - PubMed
Costantini 2010 {published data only}
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Costantini 2011 {published data only}
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Debodinance 1993 {published data only}
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Debodinance 1994 {published data only}
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Di Palumbo 2003 {published data only}
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el‐Toukhy 2001 {published data only}
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Fischer‐Rasmussen 87 {published data only}
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Foote 2007 {published data only}
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Goldberg 2001a {published data only}
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Goldberg 2001b {published data only}
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Jongen 1999 {published data only}
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- Jongen VHWM, Brouwer WK. Comparison of the modified Pereyra procedure using permanent suture material and Burch urthropexy. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1999;84:7‐11. - PubMed
Lee 1997 {published data only}
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Lemack 2008 {published data only}
Lemieux 1991 {published data only}
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Martan 2000 {published data only}
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Martan 2001 {published data only}
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Meschia 2001 {published data only}
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Morley 1995 {published data only}
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Mundy 1982 {published data only}
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- Mundy AR. The role of the Stamey bladder neck suspension procedure in the treatment of stress incontinence of urine (Abstract). Proceedings of the International Continence Society (ICS), 12th Annual Meeting, Leiden, Germany. 1982:137.
Obrink 1978 {published data only}
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Ostrzenski 1996 {published data only}
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Palomba 2001 {published data only}
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Pifarotti 2001 {published data only}
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- Pifarotti P, Spennacchio M, Gattei U, Ronchetti A, Stoppelli S, Meschia M. A randomized prospective comparison of TVT and endopelvic fascia plication in the treatment of occult stress urinary incontinence in patients with genital prolapse: Preliminary data. Urogynaecologia International Journal 2001;15(Suppl 1):55‐7.
Quadri 2000 {published data only}
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Reid 2007 {published data only}
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Richter 2007 {published data only}
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Richter 2008a {published data only}
Richter 2008b {published data only}
Roca 1994 {published data only}
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Rogers 2006 {published data only}
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Salinas 1994 {published data only}
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