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Complications of Female Incontinence Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Although the majority of stress incontinence surgeries are now performed transvaginally, (1) the abdominal urethropexy is still offered, especially in the setting of concomitant abdominal surgery. The Marshall-Marchetti-Kranz (MMK) urethropexy and the Burch colposuspension (often combined with a paravaginal repair) are the most common stress urinary incontinence (SUI) surgeries performed abdominally. The MMK involves placing sutures in the periurethral tissue and the pubic symphysis, while the Burch involves placing sutures in the paravaginal tissue and Cooper’s ligament. Complications of transabdominal urethropexy include: osteitis pubis (OP) in approximately 2.5% undergoing MMK, but is rare with Burch colposuspension; significant bleeding requiring transfusion in 1% to 2% (2); bladder or urethral injury in 1.6% with resultant fistula formation in 0.3%; prolonged urinary retention 3% to 7%; de novo voiding dysfunction 11% to 12%; wound infection 5%, urinary tract infection 4% (3,4). With a lateral defect cystocele, a paravaginal repair can be performed at the time of urethropexy. The complications associated with paravaginal repair are similar to that of urethropexy.
Safety and efficacy of robotic-assisted Burch for pure stress urinary incontinence: a large case series
Published in Journal of Obstetrics and Gynaecology, 2021
Toy G. Lee, Bekir S. Unlu, Victoria A. Petruzzi, Mostafa A. Borahay, Furkan Dursun, Antonio F. Saad, Gokhan S. Kilic
Diminished urethral support and urethral sphincter weakness are generally attributed to urethral hypermobility, which is the main cause of SUI. Urethropexy (retropubic colposuspension) is a traditional repair in women with incontinence secondary to urethral hypermobility. It was first described in 1961 (Burch 1961). Periurethral tissue is elevated and reinforced by a mini-laparotomy incision and open dissection of the retropubic space. Although a systematic review of 53 trials had reported success rates of 85−90% one year postoperatively and 70% five years postoperatively, the Burch procedure lost its popularity following the introduction of the mid-urethral sling (MUS) due to its surgical practicality (Lapitan and Cody 2012). Later, minimally invasive techniques for Burch described the advantages over open surgeries, such as shorter length of hospital stays, faster recovery, and faster return to activity (Tan et al. 2007). A recent Cochrane review of laparoscopic urethropexy included 22 randomised controlled trials (Dean et al. 2017). Cure rates of laparoscopic and open Burch urethropexy were similar, but this review revealed that laparoscopy was associated with a shorter length of hospital stays, lower morbidity, significantly fewer postoperative complications, lower estimated blood losses, shorter duration of catheterisation and significantly less pain (Dean et al. 2017). Another minimally invasive technique for Burch urethropexy is the robotic-assisted Burch urethropexy, which was first reported with two cases in 2007 by Khan et al. (2007). Our group published our initial experience with robotic retropubic urethropexy compared to open retropubic urethropexy in 2013 (Patel et al. 2013). As a result, the Burch procedure continues to have a place in the operative armamentarium of the gynaecologist and urologist.