Laparoscopic Burch bladder neck suspension: early results

The Burch suspension is an effective treatment for stress urinary incontinence due to hypermobility. To decrease the associated morbidity and hospital stay, we attempted the procedure laparoscopically in 46 women.

All patients had stress incontinence with bladder neck hypermobility. Preoperative testing included cystoscopy, multichannel urodynamics with pressure-flow studies and measurement of Valsalva leak point pressure. Mean patient age was 49.5 years (range 26 to 70).

In 12 patients the laparoscopic approach could not be completed and an open operation was performed. Of the 34 laparoscopic Burch procedures 13 were performed transperitoneally and 21 extraperitoneally. Mean operative time was 196 minutes (range 130 to 300), mean blood loss 96.3 cc (range 50 to 400) and mean postoperative hospital stay 3.2 days (range 1 to 8). Five postoperative complications included hematoma/anemia in 2 patients, transient urinary retention in 1, enterocele in 1 and uterine prolapse in 1. Mean followup was 17.3 months (range 12 to 26). Of the 34 patients only 5 had persistent incontinence postoperatively (3 with stress and urge incontinence, 1 with stress incontinence only and 1 with urge incontinence only). Overall, 85% of the patients are totally dry. With experience the operative time and postoperative stay decreased. The extraperitoneal and transperitoneal approaches provide certain advantages.

The Burch suspension performed laparoscopically appears to have a favorable morbidity profile with a successful continence outcome. However, there is a steep learning curve to the procedure as manifested by the long operative time.