Definition and Overview
Burch colposuspension, also known as a retropubic suspension, is a surgical procedure that treats stress incontinence, a condition that is more common in female patients. It aims to provide better support for the neck of the bladder, so it can stay closed under pressure.
Stress incontinence is a form of urinary incontinence, characterised by the involuntary release of urine, often during physical activities that put stress or pressure on the bladder, such as running, heavy lifting, standing up, sneezing, or coughing. Despite its name, stress incontinence is not related to psychological stress.
Who Should Undergo and Expected Results
Patients experiencing stress incontinence because of nerve or tissue damage during childbirth or those suffering from conditions that have seriously weakened the urethral sphincter or pelvic floor can be considered as ideal candidates for a Burch colposuspension. It is important to note that this procedure is only recommended for female patients.
The muscles that connect the bladder to the urethra regulate the flow of urine. As the bladder fills out, the valve-like muscle called the urinary sphincter stay shut until the individual can get to the bathroom. However, the muscles in the pelvic floor and the urinary sphincter weaken because of nerve or tissue damage during childbirth. The condition can manifest right after childbirth or even years after delivery.
Patients with stress incontinence often feel embarrassed because of the involuntary release of urine, and might be forced to limit daily activities such as exercise and other leisure activities.
In patients with severe stress incontinence, the Burch colposuspension procedure supports the neck of the bladder, which connects the bladder and the urethra. The procedure prevents the involuntary release of urine, especially during uncontrollable responses of the body, such as sneezing, laughing, and coughing.
The Burch colposuspension is often recommended for patients when other more conservative treatments, such as medication, have proven to be ineffective. Some doctors recommend alternative procedures, such as mid-urethral tape slings, autologous slings, and the injection of synthetic filler material into the bladder neck. These tapes and slings are considered to be less invasive than a Burch colposuspension, but patients who are not suitable for less invasive procedures and those who have had experienced problems in the bladder and urethra can explore a more invasive repair of the bladder neck muscles and mechanisms.
After a successful Burch colposuspension, the patient can expect a significant reduction of urinary leakage when the bladder encounters pressure.
How is the procedure performed?
The Burch colposuspension procedure is performed through the following steps:
- The patient will be placed under general anaesthesia, which means that she will be asleep throughout the whole procedure and will not feel any pain.
- The surgical team will begin by cleaning the skin of the lower abdomen, right below the pubic hairline, and shave the pubic hair to provide the surgeon better access to the area.
- A small transverse incision is then made in the lower abdomen. The bladder outlet is elevated by putting in six permanent sutures (three on each side of the bladder neck) to suspend the vagina from the side wall of the pelvis. The sutures will connect the vagina to the stronger ligaments right under the pubic bone.
- The surgeon will perform a cystoscopy to inspect the lower urinary tract to ensure that it was not inadvertently damaged by the procedure.
- The surgeon will close up the incisions made in the lower abdominal area.
- Antibiotics and blood-thinning agents might be prescribed to lower the risk of infections and the formation of blood clots.
The patient will need to stay in the hospital one to three days after the procedure while the stitches are removed after seven days. Patients may be able to return to their daily activities within a month or two.
Possible Risks and Complications
A Burch colposuspension, like other surgical procedures, comes with risks. Some of the most common include the following:
- Difficulty urinating, especially right after the procedure. The patient will need to wear a catheter to properly drain the bladder.
- Pain after the operation, which can be addressed by painkillers
- Urinary tract and wound infections, which can be treated by antibiotics
- Bruising around the incisions
Delayed healing of the wound
The procedure can also result in serious complications although the following rarely occur:
Increased frequency and urgency of urination
- Vaginal prolapse
- Perforation or damage to the bowel and bladder
- Venous thrombosis and pulmonary embolism, or blood clots in the legs and lungs, respectively. These can be addressed with blood-thinning medication and the use of compression socks or stockings.
Failure to improve symptoms of stress incontinence
Saidi MH, Gallagher MS, Skop IP, Saidi JA, Sadler RK, Diaz KC. Extraperitoneal laparoscopic colposuspension: short-term cure rate, complications, and duration of hospital stay in comparison with Burch colposuspension. Obstet Gynecol. 1998 Oct. 92(4 Pt 1):619-21.
Miklos JR, Kohli N. Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique. Urology. 2000 Dec 4. 56(6 Suppl 1):64-9.