Laparoscopic Burch Colposuspension for Urinary Stress Incontinence

To date we have performed 58 laparoscopic Burch colposuspensions, 28 by the extraperitoneal route and 30 with the transperitoneal approach. The 58 women (mean age 48.9 yrs, mean weight 71.1 kg) all underwent urodynamic studies. Sixteen had mixed findings of stress and urge incontinence. The operative technique involved dissection into the space of Retzius. Laparoscopic suturing techniques were employed using either 0 Dacron or polyester between the paravaginal fascia and the iliopectineal ligaments. Satisfactory elevation of the bladder neck was obtained. Associated procedures were predominantly laparoscopic hysterectomy. Comparison of the two approaches showed equivalent blood loss, return to normal activity, operating times, and duration of postoperative catheterization. Hospitalization was significantly longer in the extraperitoneal group. Significant complications were cystotomy in four women and conversion to laparotomy in four. Duration of follow-up was equivalent in both groups, ranging from 6 to 33 months. Success rates were also equivalent, with only one failure in total, occurring in the transperitoneal group. Laparoscopic Burch colposuspension is a safe, effective procedure and should replace the conventional approach by laparotomy.