Burch colposuspension versus fascial sling to reduce urinary stress incontinence.
BACKGROUND
Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations.


METHODS
We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events.


RESULTS
A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence.


CONCLUSIONS
The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .).
Albo
Michael E
ME
Division of Urology, University of California, San Diego, San Diego, CA 92103-8897, USA.
Richter
Holly E
HE
Brubaker
Linda
L
Norton
Peggy
P
Kraus
Stephen R
SR
Zimmern
Philippe E
PE
Chai
Toby C
TC
Zyczynski
Halina
H
Diokno
Ananias C
AC
Tennstedt
Sharon
S
Nager
Charles
C
Lloyd
L Keith
LK
FitzGerald
MaryPat
M
Lemack
Gary E
GE
Johnson
Harry W
HW
Leng
Wendy
W
Mallett
Veronica
V
Stoddard
Anne M
AM
Menefee
Shawn
S
Varner
R Edward
RE
Kenton
Kimberly
K
Moalli
Pam
P
Sirls
Larry
L
Dandreo
Kimberly J
KJ
Kusek
John W
JW
Nyberg
Leroy M
LM
Steers
William
W
D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000453:epidemiology / Q000209:etiology; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000379:methods*