Two techniques of laparoscopic Burch repair for stress incontinence: a prospective, randomized study

Abstract

Study objective: To determine if outpatient laparoscopic Burch procedure performed with mesh and staples is as effective as that done with the suture technique.

Design: Prospective, randomized study.

Setting: Community hospital.

Patients: Sixty-nine women with genuine stress incontinence (GSI) randomly assigned to either the suture group (group 1) or the mesh-staple group (group 2).

Interventions: Before surgery each patient had a complete history, physical and neurologic examinations, 24-hour urolog, urology questionnaire, urine culture and sensitivity, Q-Tip test, transperineal ultrasound, cough stress test, cystourethroscopy, and cystometrogram. Stress incontinence was diagnosed by positive Q-Tip, ultrasound, and cough stress tests and a negative cystometrogram for detrusor contraction. The laparoscopic Burch procedures were performed with either sutures for bladder neck elevation or with mesh and staples. Clinical and, if necessary, urodynamic studies were repeated at 6 weeks and 1 year postoperatively. MEASYRENEBTS AND MAIN RESULTS: The cure rate at 1 year was 91% in group 1 and 94% in group 2. Only objective cures by urologic testing are reported. The hypermobile urethra, as tested by transperineal ultrasound, was cured by both procedures. Of the 69 women, 68 were able to void spontaneously within 24 hours.

Conclusions: Early results suggest that laparoscopic Burch colposuspension is effective in curing GSI. Both sutures and mesh with staples yield good outcomes.