Burch bladder neck suspension for cystocele repair: The necessity of combined vaginal procedures for severe cases

Background: Burch operation is an accepted form of bladder neck suspension for small cystoceles. The purpose of the present study was to evaluate the efficacy of Burch repair for severe cystoceles compared with Burch repair a long with vaginal procedures. Methods: A total of 14 patients with severe cystocele (grade III-IV) treate d with open Burch operation were evaluated retrospectively. Of these patien ts, eight were Burch only and the remaining six underwent combined Burch wi th vaginal repair (anteroposterior vaginal wall plasty and hysterectomy). Results: After a mean follow up of 40 months (range 6-80), cystocele recurr ed in one patient at 1 month, and rectocele became prominent in three patie nts, including one who also presented uterine prolapse among the Burch-only group. Conversely, all six patients who underwent the combined operation s howed no occurrence of cystocele or rectocele. The proportion of patients n ot failing treatment was significantly higher in the combined operation gro up than in the Burch-only group. Intermittent self-catheterization was need ed in one patient from the combined operation group for 6 months, but all o ther patients had restored smooth urination within a few weeks after the op eration. Conclusions: The results suggest that, for severe cystoceles, Burch-only re pair is insufficient and combined Burch with vaginal repair should be used to manage various pelvic hypermobility symptoms.