title: Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence.
abstract: To report anatomic and functional outcomes 2 years after sacrocolpopexy in stress-continent women with or without prophylactic Burch colposuspension.
  
  
  
  In the Colpopexy and Urinary Reduction Efforts (CARE) trial, stress-continent women undergoing sacrocolpopexy were randomized to receive or not receive a Burch colposuspension. Outcomes included urinary symptoms, other pelvic symptoms, and pelvic support. Standardized pelvic organ prolapse quantification examinations and validated outcome measures including the Pelvic Floor Distress Inventory and the Pelvic Floor Impact Questionnaire were completed before surgery and at several postoperative intervals, including at 2 years.
  
  
  
  This analysis is based on 322 randomized participants; certain analyses were done with a subset based on data availability. Most were Caucasian (94%), with a mean age of 62±10 years (mean±standard deviation). Two years after surgery, 41.8% and 57.9% of women in the Burch and control groups, respectively, met the stress incontinence endpoint (presence of symptoms or positive cough stress test or interval treatment for stress incontinence, P=.020). The apex was well supported (point C within 2 cm of total vaginal length) in 95% of women, and this was not affected by concomitant Burch (P=.18). There was a trend toward fewer urgency symptoms in the Burch group (32.0% versus 44.5% no Burch, P=.085). Twenty participants experienced mesh or suture erosions.
  
  
  
  The early advantage of prophylactic Burch colposuspension for stress incontinence that was seen at 3 months remains at 2 years. Apical anatomic success rates are high and not affected by concomitant Burch.
  
  
  
  (www.clinicaltrials.gov), ClinicalTrials.gov, NCT00065845.
  
  
  
  I.
authors.affiliation: Department of Obstetrics and Gynecology and Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL 60153, USA. Lbrubaker@lumc.edu
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nygaard
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Anthony
authors.initials: A
authors.lastname: Visco
authors.forename: Anne M
authors.initials: AM
authors.lastname: Weber
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Cundiff
authors.forename: Paul
authors.initials: P
authors.lastname: Fine
authors.forename: Chiara
authors.initials: C
authors.lastname: Ghetti
authors.forename: Morton B
authors.initials: MB
authors.lastname: Brown
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000517:prevention & control / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000601:surgery*