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Home > Incontinence > Stress > Surgical Treatments > Burch

Laparoscopic Burch Surgical Technique

Laparoscopic Burch Urethropexy procedure can be performed through a larger abdominal wall incision (i.e. Laparotomy) or through small abdominal incisions using cameras and TV screens (i.e. Laparoscopy). Despite the Laparoscopic Burch Urethropexy surgical approach, or size of incision, the operative technique for urinary incontinence should remain the same. In an attempt to support and stabilize the urethra, sutures are placed in the vaginal wall beside the urethra and anchored to the Coopers ligament of the pubic bone. Routinely, two sutures are placed on each side of the urethra, one at the mid-level of the urethra and one at the level of the urethra bladder junction (i.e. bladder neck).

Scientific medical research suggest cure rates >90% at 1 year, 85% at 5 years, and 80% at 10 years. Most recent published literature describes the Burch urethropexy utilizing:

  • Four permanent sutures
  • Two sutures are placed at the level of the midurethra
  • Two sutures are placed at the level of the bladder neck
  • All sutures are passed through the Coopers ligament
  • Higher cure rates utilizing four sutures instead of two sutures

Diagram of Burch Urethropexy

Burch Urethropexy

Supporting the vagina (pubocervical fascia) beside the urethra is one of the two best cures for stress or activity-related urine leakage.

Dr. Miklos published a review article in the Contemporary OBGYN describing his approach in great detail.  (PDF version)

Laparoscopic Paravaginal Repair for Anterior Wall Prolapse with Burch Urethropexy

Dr. Miklos' and Dr. Moore's recent study review of the more than 200 patients who had received a laparoscopic Burch urethropexy revealed more than 90% of these patients also required a paravaginal repair. Dr. Miklos previously described combining these two surgical techniques in an attempt at restoring anterior vaginal wall anatomy and correcting the stress urinary incontinence. This surgical procedure is recommended for patients with cystocele (due to paravaginal defects) and stress urinary incontinence. The paravaginal repair is performed between the apex (highest point) of the anterior vaginal wall and the "bladder neck" (urethra meets the bladder) this part of the surgery corrects the cystocele (bladder drop). The Burch urethropexy is performed to stabilize and support the urethra.

The combined surgical procedure routinely utilizes:

  • Total of ten sutures
  • Six sutures for the paravaginal repair (cystocele repair)
  • Four sutures for the Burch urethropexy (incontinence repair)
  • All permanent sutures
Burch Urethropexy without Paravaginal Repair

Burch Urethropexy without Paravaginal Repair
Note the paravaginal defects are present. The Burch procedure will address the urine leakage, but the paravaginal defects are not addressed therefore the patient will continue with a cystocele in this area.

Burch Urethropexy without Paravaginal Repair plus burch urethropexy

Paravaginal Plus Burch Urethropexy
Not only addresses the incontinence (Burch) but also the cystocele (paravaginal repair). Dr. Miklos and Dr. Moore have found 95% of patients receiving a Burch procedure also have paravaginal defects. Therefore, most patients should have both the Burch and paravaginal repair procedures.

Side View of Laparoscopic Burch Repair without Paravaginal Repair

Cytourethrocele - lack of support og anterior vaginal wallCystourethrocele - A lack of support of the whole anterior vaginal wall

Burch Urethropexy without Paravaginal RepairBurch Urethropexy without Paravaginal Repair
The patient continues to have a cystocele, even though she had a Laparoscopic Burch procedure for her urine incontinence. If this patient would have also had a paravaginal repair, the cystocele would have been cured and her support would look like the normal support pictured above.

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