Laparoscopic Burch

Quick Facts

Urinary Incontinence:

Involuntary leakage of urine is very common in women. There are several types of incontinence, but the most common among women is called stress incontinence, which refers to loss of urine when straining (e.g., laughing, coughing, sneezing, etc.). In the United States, more than 20 million women are affected by stress incontinence. Urge incontinence is usually an uncontrollable urge to go to the bathroom, that is often followed by leakage of urine before the toilet is reached. Medications are used to treat urge incontinence. Mixed incontinence is a combination of these two types.

Left untreated, urinary incontinence can progress to the point that it becomes socially embarrassing, and has been cited as the most common reason for families to place their grandmothers in nursing homes.

Diagnosis:
Treatment for urinary incontinence varies according to the type of incontinence. The first step in treatment is accurate diagnosis. This consists of the patient’s medical and urological history, physical and pelvic examination, and some simple office tests, such as post void residual urine (the amount of urine left in the bladder after voiding), the Q-Tip test (which tells how mobile the urethra is, and if there is an anatomic component to the incontinence. Additional tests may be necessary in more complicated cases.

Procedure Choice:
Once diagnosed, stress incontinence is treated by surgery. Recently, there seems to be consensus, especially among gynecologists and urogynecologists, that the retropubic colposupsension (Burch procedure) is the surgical choice for incontinent patients with hypermobile urethra, and suburethral sling procedure (TVT) for patients with urethral sphincteric deficiency.

Past and Present:
The retropubic urethral suspension was introduced in 1910, and since then over 200 different surgical procedures for treating stress incontinence have been described. These procedures are designed to restore the bladder neck and urethra to their anatomically correct positions in patients with stress incontinence. The traditional Burch colposuspension, first described in 1961, has been considered the Gold Standard procedure. It is associated with long-term success rates ranging from 75-90%.

Today, emphasizing the principles of minimally invasive surgery, laparoscopy has evolved as an alternative technique in the treatment of genuine stress incontinence. The Laparoscopic Burch involves placing permanent suture material adjacent to the neck of the bladder on each side and attaching them to a strong ligament (Cooper’s ligament) attached to the pelvic bone. The reported advantages include improved visualization of the retro-pubic anatomy, minimal blood loss, shorter hospitalization, and faster recovery.

Benefits:
Laparoscopic Burch offers a number of benefits, including:

• 3 or 4 tiny scars instead of one large abdominal incision;

• shorter hospital stay (you may leave the same day or next day);

• reduced post-operative pain;

• faster return to work; and,

• shorter recovery time.

What To Expect:
All urinary incontinence procedures pose some risks, including bleeding, infection, or injury to the urinary tract, and vary according to the surgeon’s experience. It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for 2 to 4 weeks. Some patients may experience urinary retention due to swelling in the post-operative area, which may require a catheter for up to 10 days until the swelling subsides. In time, most patients will be able to return to the simple pleasures in life, laughing without risk of embarrassment of loss of urine.

Laparoscopic Burch

Laparoscopic surgical treatment for stress urinary incontinence

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LYNDON TAYLOR

OB/GYN

Lyndon D Taylor MD LLC

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Visit one of the Chicago area’s leading advanced laparoscopic surgeons, with offices in Westchester, Elmhurst, Melrose Park, and Oak Park, Illinois. Leading-edge medical care for women’s health conditions, including: endometriosis, uterine fibroids, chronic pelvic pain, abnormal uterine bleeding, reproductive disorders (infertility), and obstetric care. Procedures include: laparoscopic myomectomy, endometrial ablation, and laparoscopic assisted vaginal hysterectomy.