image: Kaplan-Meier curve of patient-reported continence after the Burch procedure view more
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Stress urinary incontinence (SUI) is a prevalent complaint involving involuntary loss of urine on effort or physical exertion or on sneezing or coughing, affecting about 18.9% of Chinese females, and the prevalence is predicted to increase because of the aging population in China. Several surgical procedures, including Burch colposuspension (BC) and midurethral slings (MUS), have been described for women with SUI. Although classic gold surgery BC has been largely replaced by minimally invasive MUS in recent decades, the uncommon but serious complications of the latter procedure have led to withdrawal of many MUS products. Subsequently, interest in BC as an alternative to MUS has been rekindled. Several Cochrane meta-analyses and systematic reviews reported that the overall postoperative continence rate associated with open BC was approximately 70-90% within 10 years. However, only a limited number of studies have evaluated the long-term effectiveness and safety of BC in detail for longer than 10 years, and most of them were retrospective studies.
Researchers included 84 patients with SUI in this study, among whom 57 (68%) completed the last follow-up, with a mean follow-up period of 14.2 years (range 11-17 years). The telephone follow-up rate was 82.5% (47/57). The median operative time for sole Burch procedure was 83 minute, and median blood loss was 60 ml. The median length of hospital stay was 8 days. At the latest follow-up, 68.4% of patients (39/57) had no complaints of SUI symptoms, and 73.6% of patients (42/57) reported themselves subjectively satisfied following the BC, as indicated by the PGI-I. In addition, 68.4% of patients (39/57) reported subjective success regarding urinary symptoms, with a 70% UDI-6 score reduction. Postoperative IIQ-7 scores were reduced significantly, indicating that patients’ quality of life had improved significantly by the 14-year follow-up. However, 28.1% (16/57) suffered at least one long-term complications and incidents during the follow-up period. Specifically, 1 in 25 (4.0%) sexually active patients reported dyspareunia, 3 patients (5.3%) had de novo overactive bladder, and 6 patients (10.5%) reported voiding dysfunction. Four patients (7.0%) reported new onset prolapse symptoms, and 3 patients (5.3%) underwent secondary urinary incontinence surgery.
This study confirms the effectiveness of Burch colposuspension for women with SUI in the long term. BC can be considered an option for treating SUI, especially when concomitant intraabdominal surgery is arranged or when the patient is particularly concerned about complications associated with the synthetic mesh used in MUS procedures.
This study was supported by the National Natural Science Foundation of China (No. 81830043 and 81771561), and the National Key R&D Program of China (2018YFC2002201)
See the article:
Ye, Y., Wang, Y., Tian, W., Zhang, Z., Liang, S., Song, X., Guo, J., Gao, Q., Shi, H., Sun, Z., et al. (2021). Burch colposuspension for stress urinary incontinence: a 14-year prospective follow-up. Sci China Life Sci 64, https://doi.org/10.1007/s11427-021-2042-9. http://engine.scichina.com/doi/10.1007/s11427-021-2042-9
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Science China Life Sciences