Randomised trial of laparoscopic Burch colposuspension versus tension-free vaginal tape: long-term follow up.
OBJECTIVE
To compare the long-term efficacy of laparoscopic Burch colposuspension with tension-free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI).


METHODS
Long-term follow up from a prospective randomised trial.


METHODS
Academic tertiary referral centre.


METHODS
Seventy-two women with urodynamic SUI from two institutions.


METHODS
Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow-up evaluations occurred 6 months, 1 year, 2 years, and 4-8 years after surgery.


METHODS
Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient Global Impression of Improvement (PGI-I) scales.


RESULTS
Median follow-up duration was 65 months (range 12-88 months) with 92% completing at least one follow-up visit. Seventy-four percent of subjects had long-term (4-8 years) follow up. Fifty-eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4-8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71-2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4-8 years after surgery (P = 0.26). There was significant improvement in the postoperative UDI-6 and IIQ-7 scores in both groups at 1-2 years that were maintained throughout follow up with no significant differences between the groups.


CONCLUSIONS
TVT has similar long-term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4-8 years after surgery; however, the majority of incontinence is not bothersome.
Jelovsek
J E
JE
Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH 44195, USA. jelovsj@ccf.org
Barber
M D
MD
Karram
M M
MM
Walters
M D
MD
Paraiso
M F R
MF
D003127:Colposcopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D053825:Suburethral Slings; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics