Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study

A retrospective comparison was made of the urodynamic parameters of urethral sphincteric function of 21 women with failure of modified Burch retropubic urethropexy and 21 matched control subjects in whom operation was successful. The match criteria included multiple risk factors that contributed to the failure of antiincontinence surgery. The preoperative resting urethral closure pressure and urethral functional length were significantly lower in the study (failure) group than in the control (success) group. These parameters of intrinsic urethral function improved only in the control (success) group after operation. Further study showed that 17 of the 21 patients (81%) in the control (success) group had preoperative closure pressure greater than 20 cm H2O, whereas only five of the 21 patients (24%) in the study (failure) group had initial closure pressure higher than this value. Identification of a low-pressure urethra by preoperative urethral profilometry suggests a greatly increased risk for operative failure.