One expert's opinion: Burch colposuspension still has its place.(Gynecology)

FORT LAUDERDALE, FLA. -- Burch colposuspension isn't the newest or fanciest of the ever-expanding surgical options for treating urinary stress incontinence, but it does have a solid place in the surgical armamentarium for this condition, Matthew Barber, M.D., said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

"In my opinion, Burch colposuspension is the standard by which all other surgeries for genuine stress incontinence should be compared," said Dr. Barber of the Cleveland Clinic.

Numerous studies over the past decade have upheld the efficacy and safety of this procedure, he noted.

Systematic reviews of the literature in 1996 and 1997, for example, showed that colposuspension is more effective and long lasting than anterior repair or needle suspensions, and is as effective as sling procedures. And a 2001 study of 124 patients with 10- to 15-year follow-up showed a 94% long-term cure rate.

When compared with the traditional bladder neck sling and the use of tension free vaginal tape (TVT), the Burch procedure also compared favorably. In four randomized controlled trials, there was no difference in efficacy between the bladder neck sling and the Burch procedure, although in observational studies, a slightly higher rate of voiding dys-function was seen with the Burch procedure.

In the largest ...