Burch Colposuspension for Stress Urinary Incontinence

Primary Recommendation

• The American Urological Association recommends Burch colposuspension as a viable surgical option for stress urinary incontinence (SUI) in women who refuse synthetic mesh or are undergoing concurrent open/minimally invasive abdominal-pelvic surgery 1, 2, 3, 4

Current Position in Treatment Algorithm

When to Offer Burch Colposuspension

• Burch colposuspension is considered a first-line treatment for women with SUI who decline synthetic mesh after thorough counseling about mesh risks and benefits 1, 2
• Burch colposuspension is an opportunistic indication for women undergoing concomitant open, laparoscopic, or robotic abdominal-pelvic surgery 1, 2, 3, 4
• Burch colposuspension is an acceptable alternative when autologous fascia pubovaginal sling is not feasible or desired 1, 2

Efficacy Data

• Short-term success (12-23 months) of open Burch colposuspension shows 81-82% cure/dry rates 5, 6
• Medium-term (24-47 months) success of open Burch colposuspension shows 76% cure/dry rates 5, 6
• Long-term (≥48 months) success of open Burch colposuspension shows 73-78% cure/dry rates 5, 6
• Laparoscopic approach shows 69-74% cure/dry rates, with comparable outcomes to open technique 5, 6

Comparative Effectiveness

Burch vs. Autologous Fascial Sling

• The SISTEr trial demonstrated autologous fascial pubovaginal sling superiority over Burch colposuspension, with 66% vs. 49% success rates and lower re-treatment rates at 5-year follow-up 1, 2, 3, 4

Burch vs. Synthetic Midurethral Slings

• Retropubic midurethral slings (TVT) show essentially equivalent outcomes to Burch colposuspension in multiple RCTs 1, 2
• Synthetic midurethral slings demonstrate 84% cure/dry rates at short and long-term follow-up 5, 6

Complication Profile

Urge Incontinence Risk

• De novo urge incontinence occurs in 8% of patients after open Burch without concurrent prolapse repair 5
• De novo urge incontinence with prolapse repair occurs in 14% of patients 5
• Preexisting urge incontinence persists in 17% of patients postoperatively without prolapse repair, and 22% with concurrent prolapse repair 5

Urinary Retention Risk

• Retention >1 month or requiring intervention occurs in 3-4% of patients after open Burch 5, 6
• Retention rate is 1% with concurrent prolapse repair 5, 6

Operative Considerations

Special Clinical Scenarios

Technical Approach Options

Open vs. Laparoscopic

• Open approach shows 81-82% cure rates at 12-23 months 5, 6
• Laparoscopic/extraperitoneal approach shows 69% cure rates with significant quality of life improvements and fewer apparent compromises in outcomes 5, 6

Critical Pitfalls to Avoid

• Inadequate preoperative counseling must discuss that autologous fascial slings have superior long-term outcomes with lower re-treatment rates 1, 2
• Expecting mesh-equivalent outcomes, as Burch has lower success rates than synthetic midurethral slings in most comparative studies 1, 5