A randomized trial of Burch retropubic urethropexy and anterior colporrhaphy for stress urinary incontinence

Objective: In a randomized trial, we compared the success of Burch retropub ic urethropexy to the modified anterior colporrhaphy for the treatment of g enuine stress urinary incontinence. Methods: Thirty-five patients with stress incontinence were randomly assign ed to undergo Burch retropubic urethropexy or modified anterior colporrhaph y. Subjects had preoperative and 1-year postoperative physical examinations , multichannel urodynamic testing, 20-minute pad test, and subjective gradi ng of incontinence severity with questionnaires. Data were evaluated using Fisher exact test, Wilcoxon two-sample test, logistic regression analysis, and analysis of variance. Results: Objective cure 1 year postoperatively was significantly greater fo r the women treated by Burch retropubic urethropexy than by modified anteri or colporrhaphy (16 of 18 [89%] versus five of 16 [31%], relative risk .15, 95% confidence interval .04, .59). Patients' subjective ratings of inconti nence severity 1 year after surgical treatment were significantly lower in women who had Burch retropubic urethropexy. Conclusion: Burch retropubic urethropexy yields a significantly superior ob jective cure for genuine stress urinary incontinence than the modified ante rior colporrhaphy in a randomized trial. (C) 1999 by The American College o f Obstetricians and Gynecologists.