[Burch laparoscopic colposuspension. Results of 30-month follow-up]

Burch colpo-suspension, which is the present gold standard for treatment of stress urinary incontinence, may be performed laparoscopically.

The aim of this retrospective study was to report the results of laparoscopic Burch colpo-suspension with a 30-month follow-up and to assess the reason for the unsuccessful results.

From 1990 to 1999, 118 patients (mean age: 46 years) were operated on for stress urinary incontinence with laparoscopic colpo-suspension. Urinary incontinence was classified grade 1 (6%), 2 (67%) and 3 (27%). The Burch colpo-suspension was performed through extraperitoneal approach in 51% and transperitoneal in 49%. A genital prolapse was associated in 31% of the patients and treated with sacropexy. A subtotal hysterectomy was performed in 25% of the patients and a vaginal hysterectomy in 46%.

Global morbidity rate was 19%, including four cases of bladder injury. With a 30-month follow-up, 76/118 (64.4%) had no more urinary incontinence. Parity, age, previous pelvic surgery, detrusor instability and low urethral closure pressure were not predictive of recurrent stress urinary incontinence after treatment. Associated sacropexy was only correlated with a high risk of failure (P = 0.04). Patients with hysterectomy had significantly better results (72% vs 41.9%) (P = 0.05). Trans- and extraperitoneal techniques had similar results (P = 0.7).

With a 30-month follow-up, 64.4% of the patients had satisfactory results with strictly no more stress urinary incontinence. There was no significant difference between the trans- and the extraperitoneal approach. Sacropexy was only associated with a higher rate of failure.