Clinical outcomes with laparoscopic approaches and open Burch procedures for urinary stress incontinence

Laparoscopic minimally invasive approaches to urinary stress incontinence have been described in the literature since 1989. Technical advances have improved both access to the space of Retzius and the operator's ability to accomplish retropubic colposuspension. In addition to the traditional open Burch procedures, a new laparoscopic method of colposuspension is available. In one group of women, laparoscopically guided procedures were performed in the classic fashion using only sutures. In the second laparoscopic group the suspension was performed with a combination of sutures and endoscopic staples (Nolan-Lyons modification of the Burch). The third group was analyzed retrospectively by chart review and patient interview for surgical outcome data. All groups were similar demographically. Clinical outcomes were similar in the laparoscopic groups, and surgical morbidity was significantly decreased compared with traditional open procedures. Relief of symptoms was similar in all groups at 1-year follow-up. We conclude that a laparoscopic approach to retropubic colposuspension is an effective alternative with improved clinical outcomes. Additional modifications that can improve surgeons' accessibility to these techniques are feasible, with comparable clinical outcomes.