COMPARISON OF BURCH AND LYODURA SLING PROCEDURES FOR REPAIR OF UNSUCCESSFUL INCONTINENCE SURGERY

Objective: To assess the effectiveness and late postoperative morbidit y of the Burch procedure and the sling procedure for the treatment of recurrent urinary stress incontinence after vaginal hysterectomy and a nterior repair. Methods: Clinical, urodynamic, and sonographic examina tions were done on 77 women suffering with recurrent urinary stress in continence. The women were randomized to two groups, modified Burch co lposuspension and lyophilized dura mater sling surgery; 72 women were reexamined 32-48 months after these procedures. Results: The cure rate at 32-48 months' follow-up was 86% for the Burch procedure and 92% fo r the sling. Women who had had the sling procedure demonstrated a clea r decrease in maximal bladder capacity, from 330 to 240 mL (P < .05). In both groups, stress profiles demonstrated a shift of maximal pressu re point toward the proximal urethra and a significant improvement in pressure transmission (P < .05). The postoperative patients who had pe rsistent incontinence were found to have insufficient elevation of the bladder neck (less than 10 mm). The uroflow examination showed an inc rease of urination time in both groups. The incidence of bladder probl ems was 10% with the Burch procedure and 29% with the sling procedure; however, 13% of the Burch group developed rectoceles. Conclusion: Bot h procedures offer a high rate of success. We believe that the sling s urgery should be used only in certain special cases because of its hig her rate of complications, but that posterior vaginal repair should be considered after modified Burch colposuspension because of the possib ility of rectocele and enterocele.