title: Burch colposuspension versus fascial sling to reduce urinary stress incontinence.
abstract: 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] .).
authors.affiliation: Division of Urology, University of California, San Diego, San Diego, CA 92103-8897, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Albo
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
authors.forename: Toby C
authors.initials: TC
authors.lastname: Chai
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.forename: Ananias C
authors.initials: AC
authors.lastname: Diokno
authors.forename: Sharon
authors.initials: S
authors.lastname: Tennstedt
authors.forename: Charles
authors.initials: C
authors.lastname: Nager
authors.forename: L Keith
authors.initials: LK
authors.lastname: Lloyd
authors.forename: MaryPat
authors.initials: M
authors.lastname: FitzGerald
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.forename: Harry W
authors.initials: HW
authors.lastname: Johnson
authors.forename: Wendy
authors.initials: W
authors.lastname: Leng
authors.forename: Veronica
authors.initials: V
authors.lastname: Mallett
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stoddard
authors.forename: Shawn
authors.initials: S
authors.lastname: Menefee
authors.forename: R Edward
authors.initials: RE
authors.lastname: Varner
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Pam
authors.initials: P
authors.lastname: Moalli
authors.forename: Larry
authors.initials: L
authors.lastname: Sirls
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Dandreo
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Leroy M
authors.initials: LM
authors.lastname: Nyberg
authors.forename: William
authors.initials: W
authors.lastname: Steers
mesh_terms: 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*