Since the introduction of the urethral suspension procedure in 1910, over 100 different surgical techniques for the treatment of genuine stress urinary incontinence have been described. Recently the American Urology Association has confirmed the two curative and enduring operations are the Laparoscopic Burch urethropexy and the pubovaginal sling. Dr. John Burch introduced the Burch colposuspension in 1961, which remains an outstanding operation for the treatment of activity related urinary incontinence. By emphasizing the principles of minimally invasive surgery, we have successfully adopted the laparoscopic Burch procedure. Drs. Miklos and Moore perform the Laparoscopic Burch procedure with no modifications of the open procedure with the only exception is the laparoscopic incisions instead of a large open incision.
Most recent published literature describes the Burch urethropexy utilizing:
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Four permanent sutures |
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Two sutures are placed at the level of the midurethra |
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Two sutures are placed at the level of the bladder neck |
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All sutures are passed through the Coopers ligament |
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Higher cure rates utilizing four sutures instead of two sutures |
Burch Urethroplexy - Supporting the vagina (pubocervical fascia) beside the urethra is one of the two best cures for stress or activity related urine leakage.
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Laparoscopic Burch: Figure 2
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Results
Drs. Miklos and Moore have experienced a long-term cure rate of 90% with the laparoscopic Burch procedure. These results are similar to a study in Obstetrics and Gynecology revealing an equal cure rate for laparoscopic vs. laparotomy over 2 years. With these results, we believe the laparoscopic Burch is a superior procedure over the conventional Burch, especially since results are similar without the disadvantage associated with a large incision.
Many patients feel that they must live with incontinence once they have had a failed incontinence procedure. We demonstrate a 90% cure rate in patients undergoing a laparoscopic Burch in those patients who have undergone previous procedures for incontinence. Drs. Moore and Miklos's results were published in the Journal of the American Association of Gynecologic Laparoscopists. Conventional wisdom states that repeat incontinence surgery should have a lower chance of success than a patient receiving surgery for the first time. Drs. Moore and Miklos' article shows even higher cure rates for repeat procedure with Burch laparoscopy than most physicians have published for primary procedures.
Complications
Because of Drs. Miklos and Moore 's vast experience in the laparoscopic Burch and/or paravaginal repair, their complication rate is lower than most physicians. A study by Drs. Harris and Cundiff from Duke University Medical Center revealed a 3.3% bladder and 6.7% ureter complication rate during the abdominal Burch procedure compared to our laparoscopic Burch complication rate of 2.3% bladder and 0% ureter.
Laparoscopic Burch: Figure 3 Dr. Miklos published his complication rate in a series of 171 patients in the Journal of Urology. Of the 171 patients, 4 (2.3%) had injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair. All 4 injuries were cystotomies (unavoidable entry into the bladder) in which 2 were in patients with previous abdominal retropubic urethropexies. Previous surgery in this area dramatically increases scar tissue making dissection difficult thus increasing the incidence of bladder injury. No ureteral ligation or placement of suture into the bladder was diagnosed. Other surgical parameters for our laparoscopic Burch urethropexy and paravaginal repair include an estimated blood loss of 50 mL, average hospital stay of less than 23 hours, and an average operative time of 50 minutes. All patients had their surgery completed via laparoscopy.
The literature review and our personal experience suggest that the laparoscopic Burch urethropexy and paravaginal repair procedure is safer and has fewer complications than the traditional open laparotomy for the treatment of stress urinary incontinence and cystourethrocele resulting from lateral vaginal wall defects.
Drs. Buller and Cundiff at The Johns Hopkins University Medical Center wrote a comprehensive review on laparoscopic surgeries for urinary incontinence. These physicians state, "The majority of the data for laparoscopic surgeries for the treatment of urinary incontinence suggest that the success rates are similar and complication rates are lower than those for the open procedure."Buller and Cundiff also discuss the doubt about long-term results. The conclusion was that long-term results are determined by the physician's experience and if the physician modifies the procedure. To date, Dr. Miklos and Moore have performed more than 700 laparoscopic Burch and/or paravaginal repairs with no modifications of the Burch procedure.
General Complications of Laparoscopic Burch
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Bladder or Ureter Injury |
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Voiding Dysfunction |
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Hemorrhage |
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Incomplete Bladder Emptying |
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Urinary Retention |
Atlanta Urogynecology Associates Experience
Drs. Miklos and Moore have per anti incontinence surgery. Because of this vast experience with Burch laparoscopy, they are able to achieve high cure rates and low complications from the laparoscopic Burch procedure with a successful long-term outcome. By performing the Burch in the original manner in which it was designed, we have taken a proven open surgery and applied our advanced laparoscopic skills to allow for smaller incisions and a shorter recuperation time. Dr. Miklos and Moore have performed just as many, if not more, laparoscopic Burch and or paravaginal repairs than most surgeons in the country. Their published series of 171 patients as noted above constitutes the largest known published series in the English literature. These 171 patients account for less than 2.5 years of their total surgical series. They also have the largest series in the English literature of complicated laparoscopic Burch procedures which are performed in patients that have had previous surgeries. Today's surgeons rarely achieve these results.
