Burch colposuspension: Long-term results and review of published reports

Objectives. To review our long-term results with the Burch colpocystourethr opexy, compare our results with those in recently published reports, and de fine factors that may influence the long-term outcome of this procedure. Methods. A group of 79 patients who underwent Burch colposuspension as modi fied by Tanagho between January 1985 and January 1991 were studied retrospe ctively. Preoperative investigation consisted of clinical history, physical examination, cystourethroscopy, multichannel urodynamic evaluation, includ ing pressure-flow studies, and static and dynamic urethral pressure profile analysis. A postal survey was sent to all patients to evaluate their sympt oms and the impact on their quality of life. Results. The mean follow-up was 7.6 years (range 5.3 to 10.8). Forty-four p ercent of patients were considered cured (responders), 25% significantly im proved (partial responders), and 31% failures (nonresponders). The success rate was higher among patients who had not undergone previous continence su rgery (75%) or hysterectomy (78%) than among those who had previously under gone continence surgery (59%) or hysterectomy (65%). Seventy-five percent o f the patients were responders or partial responders if the bladder was sta ble preoperatively, as opposed to 70% when the bladder was unstable before surgery. Analysis of the postal questionnaire indicated a statistically sig nificant difference in terms of irritative symptoms between the responder a nd partial responder groups combined and the nonresponder group. Conclusions. More than two thirds (69.6%) of our patients who underwent a B urch-Tanagho colpocystourethropexy had a favorable long-term outcome (mean 7.6 years), Previously failed continence procedures, unstable bladder preop eratively, and previous or concomitant hysterectomy had a negative influenc e on the final outcome in the long term from the clinical point of view, ev en if, statistically, the difference was not significant. The incidence of irritative symptoms and nocturia were significantly higher among nonrespond ers than among responders and partial responders. More attention paid to th ese symptoms during the postoperative follow-up should increase the percept ion of success by the patient after retropubic colpocystourethropexy. UROLO GY 54: 808-814, 1999. (C) 1999, Elsevier Science Inc.