Laparoscopic Burch colposuspension after failed sub-urethral tape procedures: a retrospective audit

Abstract

Our objective was to evaluate the outcome of laparoscopic Burch colposuspension in women with recurrent stress urinary incontinence after failed primary sub-urethral tape procedures. A total of 16 patients were identified, and their data from symptom-specific questionnaires, urodynamic studies and urogynaecological assessment were collected. At a median follow-up of 24.5 months, objective and subjective cure rates were 54.5% and 92.9%, respectively. Average satisfaction score regarding outcome after surgery was 9.3 on a rating scale from 0 to 10. All but one patient had symptoms of urge incontinence pre-operatively with 64.3% experiencing cure or improvement post-operatively. Voiding difficulties were observed in one patient, and post-operative urodynamics revealed a significant decrease in urinary flow rate (p < 0.05) but with no difference in urinary residuals or maximum urethral closure pressure. Severe peri-urethral fibrosis was identified in 62.5% of the patients. Laparoscopic Burch colposuspension is an effective and safe surgical option.

What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation

“…The cure rates approach those previously reported by us for repeat colposuspension after previous failed retropubic surgery [20] but are lower compared with our reported success rates for primary colposuspensions [21]. De Cuyper et al evaluated the performance of laparoscopic Burch colposuspension in a similar group of patients with reported objective cure rate of 54.5% [15]. This difference could be related to the variations in surgery in respect of the laparoscopic approach and in the number (two versus four) and type (Ethibond versus polydioxanone) of sutures.…”

“…However, further surgical management is requested by some patients with persistent or recurrent SUI. The available surgical options are periurethral injection of bulking agents [6], shortening of the existing tape [7,8], repeat midurethral tape [9][10][11][12], adjustable slings [13], spiral slings [14], autologous fascial slings, open colposuspension, laparoscopic colposuspension [15], or placement of an artificial urinary sphincter . To date, little is known about the outcome of open colposuspension in this group of patients.…”

Long-Term Results of Laparoscopic Burch Colposuspension for Stress Urinary Incontinence in Women

“…Therefore, laparoscopic colposuspension avoids the potential, long-term complications of mesh in childbearing young women or patients with poor vaginal tissue vascularity due to high risk of mesh erosion. Lastly, laparoscopic colposuspension might be another option for women after failed suburethral tape procedure (22). In fact, the frequency of laparoscopic colposuspension has markedly decreased.…”

Management of Stress Urinary Incontinence Following a Failed Midurethral Tape

“…In our unit, we offer open Burch colposuspension to patients after failed midurethral tape, with an objective cure rate of 77% and subjective cure rate of 85% (personal communication). Limited data regarding the use of laparoscopic Burch colposuspension have not been so encouraging, with an objective cure rate of 54% and subjective cure rate of 64% [21]. The performance of an autologous fascia pubovaginal sling procedure has not been evaluated following a failed midurethral tape but could be a feasible option, especially for patients with suspected intrinsic sphincter deficiency.…”