Burch procedure compared with sling for stress urinary incontinence: a decision analysis

Area of Science:

• Urology
• Gynecology
• Surgical Innovation

Background:

• Genuine stress urinary incontinence (SUI) with urethral hypermobility is a common condition in women.
• Surgical interventions like Burch colposuspension and sling procedures are primary treatments for SUI.
• Comparing the efficacy and safety profiles of these procedures is crucial for clinical decision-making.

Purpose of the Study:

• To compare the relative risks and benefits of Burch colposuspension versus sling procedures for primary surgical treatment of genuine stress urinary incontinence in women.
• To evaluate the effectiveness of each procedure, considering cure rates and potential complications.

Main Methods:

• A decision analytic model was employed to compare Burch colposuspension and sling procedures.
• Data on risks and benefits were synthesized from published literature.
• Treatment effectiveness was defined as cure of incontinence after initial and secondary treatments, with analyses including cure, persistent incontinence, de novo detrusor instability, and urinary retention.

Main Results:

• Both Burch colposuspension and sling procedures demonstrated similar overall effectiveness, with cure rates of 94.8% and 95.3%, respectively.
• Sensitivity analyses indicated the Burch procedure was more effective when sling retention risk exceeded 9.0% or de novo detrusor instability risk exceeded 10.3%.
• Conversely, the sling procedure was more effective when de novo detrusor instability risk after Burch exceeded 6.8%.

Conclusions:

• Burch colposuspension and sling procedures are comparably effective for the primary surgical management of genuine stress urinary incontinence in women.
• The choice between procedures may be influenced by the specific risk profiles of complications such as urinary retention and de novo detrusor instability.