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Reducing Urinary Incontinence After Surgery for Pelvic-Organ Prolapse
Burch colposuspension performed prophylactically during pelvic-organ prolapse repair significantly reduced postoperative stress incontinence.
Many gynecologic surgeons have performed prophylactic stress-incontinence procedures during pelvic-organ prolapse surgery. However, this surgical combination has not previously been evaluated in a well-controlled trial. This NIH-funded, multicenter, U.S. trial was conducted to evaluate whether conducting a Burch colposuspension — a type of urethral-vesicle suspension — at the time of abdominal sacrocolpopexy for pelvic-organ prolapse reduces the risk for postoperative stress incontinence.
These researchers randomized 322 women (mean age, 61; >90% white) who did not have symptoms of stress urinary incontinence and who were planning to have abdominal sacrocolpopexy either to have or not have a concomitant Burch colposuspension. Preoperative urodynamic study results were not available to the surgeons. The participants and research staff were unaware of the treatment assignment for at least 3 months postoperatively. Most participants (70.1%) had undergone prior hysterectomy.
Women were evaluated 3 months following surgery. Significantly fewer women in the Burch group than in the control group met one or more criteria for stress incontinence (23.8% vs. 44.1%); there was a similar difference among the 231 women who completed 1 year of follow-up. Stress incontinence considered bothersome by the women was also significantly less common in the Burch group (6.1% vs. 24.5%). Urinary urgency occurred in approximately one third of participants in both groups, and urinary retention occurred in one woman in each group. Serious adverse events occurred in similar proportions in the two groups. Because the Burch procedure was so decisively associated with prevention of incontinence, recruitment was stopped after the first interim analysis at the recommendation of the data and safety monitoring board.
Comment: This landmark, randomized surgical trial supports the clinical impression that Burch colposuspension prevents stress urinary incontinence associated with abdominal sacrocolpopexy for pelvic-organ prolapse. Although the study’s short-term findings are convincing, longer follow-up of study participants will determine whether the benefits of the procedure persist over the long term. Also, readers should be aware that these findings cannot be generalized to midurethral sling procedures, which are now commonly performed for stress incontinence.
— Andrew M. Kaunitz, MD
Published in Journal Watch Women's Health June 6, 2006
Citation(s):
Brubaker L et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2006 Apr 13; 354:1557-66.
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