LAPAROSCOPIC BURCH BLADDER NECK SUSPENSION - EARLY RESULTS

Purpose: The Burch suspension is an effective treatment for stress uri nary incontinence due to hypermobility. To decrease the associated mor bidity and hospital stay, we attempted the procedure laparoscopically in 46 women. Materials and Methods: All patients had stress incontinen ce with bladder neck hypermobility. Preoperative testing included cyst oscopy, multichannel urodynamics with pressure-flow studies and measur ement of Valsalva leak point pressure. Mean patient age was 49.5 years (range 26 to 70). Results: In 12 patients the laparoscopic approach c ould not be completed and an open operation was performed. Of the 34 l aparoscopic Burch procedures 13 were performed transperitoneally and 2 1 extraperitoneally. Mean operative time was 196 minutes (range 130 to 300), mean blood loss 96.3 cc (range 50 to 400) and mean postoperativ e hospital stay 3.2 days (range 1 to 8). Five postoperative complicati ons included hematoma/anemia in 2 patients, transient urinary retentio n in 1, enterocele in 1 and uterine prolapse in 1. Mean followup was 1 7.3 months (range 12 to 26). Of the 34 patients only 5 had persistent incontinence postoperatively (3 with stress and urge incontinence, 1 w ith stress incontinence only and 1 with urge incontinence only). Overa ll, 85% of the patients are totally dry. With experience the operative time and postoperative stay decreased. The extraperitoneal and transp eritoneal approaches provide certain advantages. Conclusions: The Burc h suspension performed laparoscopically appears to have a favorable mo rbidity profile with a successful continence outcome. However, there i s a steep learning curve to the procedure as manifested by the long op erative time.