Minimally Invasive Burch Colposuspension to Reduce De Novo Stress Incontinence: The MICRO Randomized Trial

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Pelvic Floor Disorders

Background:

• Stress urinary incontinence (SUI) is a common complication after pelvic organ prolapse surgery.
• Minimally invasive sacrocolpopexy is a standard surgical approach for pelvic organ prolapse.
• The role of prophylactic anti-incontinence procedures during sacrocolpopexy is not fully established.

Purpose of the Study:

• To evaluate if adding a prophylactic retropubic colposuspension improves outcomes compared to no anti-incontinence procedure.
• To determine the effect on de novo stress urinary incontinence rates after minimally invasive sacrocolpopexy.

Main Methods:

• A randomized superiority trial involving stress-continent patients undergoing minimally invasive sacrocolpopexy.
• Patients were randomized to receive either prophylactic retropubic colposuspension or no additional procedure (control).
• The primary outcome was de novo SUI at 3 months, defined by validated questionnaires, stress tests, or SUI treatment.

Main Results:

• Postoperative de novo SUI occurred in 50.0% of the colposuspension group and 41.7% of the control group (P = 0.555).
• No significant differences were observed in urinary frequency, urgency incontinence, or urinary retention between groups at 3 months.
• The study met its sample size target to detect a 15% superiority margin.

Conclusions:

• Prophylactic retropubic colposuspension was not superior to no anti-incontinence procedure in preventing de novo SUI after minimally invasive sacrocolpopexy.
• The findings suggest that routine addition of this procedure may not be beneficial for stress-continent patients.
• Further research may explore alternative strategies for SUI prevention in this population.