A randomized controlled trial comparing a modified Burch procedure and a suburethral sling: long-term follow-up

Area of Science:

• Urology
• Gynecology
• Pelvic Floor Surgery

Background:

• Stress urinary incontinence (SUI) affects many women, often linked to urethral hypermobility and low urethral pressure.
• Surgical interventions aim to restore urethral support and improve continence.
• The modified Burch procedure and sling placement are common surgical options for SUI.

Purpose of the Study:

• To compare the long-term efficacy and outcomes of a modified Burch procedure versus a sling procedure for treating SUI in women with low-pressure urethras.
• To evaluate objective and subjective cure rates, as well as voiding function, after both surgical interventions.

Main Methods:

• A randomized controlled trial involving 36 women with urodynamic stress incontinence and low-pressure urethras.
• Participants were assigned to either a modified Burch procedure (n=19) or a sling placement (n=17).
• Primary endpoint was objective cure (negative stress test and pad test); secondary endpoints included subjective cure and voiding function.

Main Results:

• Long-term follow-up (mean 72.6 months) was available for 82% of patients.
• Objective cure rates were 84.6% for the Burch group and 100% for the sling group (P=0.17).
• No significant differences were observed in mean uroflowmetry, postvoid residual volumes, or subjective cure rates between the groups. Two sling patients (12%) required partial resection due to erosion but remained continent.

Conclusions:

• Both modified Burch and sling procedures offer comparable long-term success in treating stress urinary incontinence in women with low-pressure urethras.
• Voiding function was not significantly affected by either surgical approach.
• While sling procedures showed a trend towards higher objective cure rates, the difference was not statistically significant, and erosion is a potential complication.