Laparoscopic burch repair compared to laparotomy Burch for cure of urinary stress incontinence

Sixty-two women underwent either laparoscopic Burch urethropexy or open Burch urethropexy for surgical correction of genuine stress urinary incontinence. Only patients with no prior incontinence surgery and with demonstrated genuine stress incontinence were included. Clinical evaluations were done preoperatively, at 3 months and 1 year postoperatively for objective cure. The preoperative evaluation included a 24-hour urolog, urology questionnaire, Q-tip test, cough stress test, perineal ultrasound, cystourethroscopy and simple-channel cystometrics. At follow-up all patients had repeat Q-tip test, perineal ultrasound and cough stress test. If there was any sign of leaking a repeat single-channel cystometrogram was done. Only patients with a negative objective study were considered cured. Differences in laparoscopic versus laparotomy cure rates at 1 year were insignificant (94% versus 93%). Both procedures stabilized the urethrovesical junction and prevented its descent during straining, as demonstrated by the postoperative Q-tip test and the perineal ultrasound. The two bladder procedures had comparable operative times but patients with laparoscopy voided earlier, were outpatients, and returned to work earlier. In conclusion, short-term results suggest that the laparoscopic Burch urethropexy can give similar results to laparotomy Burch urethropexy for correction of genuine stress incontinence.Editorial Comment: This is one of the more complete comparative studies of the laparoscopic and open Burch procedures. Although the study is not prospectively randomized, nor were sophisticated urodynamic studies done in all patients, it contains valuable pre- and postoperative information, particularly about the correction of urethrovesical junction mobility as measured by perineal ultrasound. This test demonstrated that both procedures are equally successful in stabilizing the urethrovesical junction. Unfortunately, the cure of stress incontinence was based on stress test alone, with only 4 patients having a CMG postoperatively. By that standard the cure rates of both procedures do not differ. However, we should be cautious in recommending the laparoscopic procedures of research protocols until a prospective randomized comparison utilizing objective urodynamic studies is available. The American Urogynecologic Society has such a multicenter study under way, and we await the results.