Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse

Objective To compare the Burch colposuspension and the anterior colporrhaph y in women with both stress urinary incontinence and advanced anterior vagi nal wall prolapse (cystocele). Design Prospective randomised study. Setting Secondary referral centre, Urogynaecology Unit, San Gerardo Hospita l, Monza, Italy. Sample Seventy-one women undergoing surgery for primary genuine stress inco ntinence and concurrent grade 2 or 3 cystocele (descending at or outside th e vaginal introitus). Methods Full urodynamic investigation performed pre-operatively and repeate d six months after surgery. Clinical follow up continued for 8 to 17 years. Main outcome measures Subjective (patient history) and objective (negative stress test result) cure of stress incontinence. Assessment of cystocele re currence. Results Thirty (86%) of the 35 evaluable women who had the Burch colposuspe nsion and 17 (52%) of the 33 evaluable women who had the anterior colporrha phy were subjectively cured (OR 5.6, 95% CI 1.6 to 21.6; P = 0.005). Object ive cure rates were 74% (26 of 35) and 42% (14 of 33), respectively (OR 3.9 , 95% CI 1.3 to 12.5; P = 0.02). A recurrent cystocele of grade 2 or 3 with or without prolapse at other vaginal sites was recorded in 34% (12 of 35) and 3% (1 of 33) of women, respectively (OR 16.7, 95% CI 2.0 to 368.1; P = 0.003). Conclusions The Burch colposuspension was better in controlling stress inco ntinence but it lead to an unacceptable high rate of prolapse recurrence. T he anterior colporrhaphy was more effective in restoring vaginal anatomy bu t it was accompanied by an unacceptable low cure rate of stress incontinenc e. Neither of the two operations is recommended for women who are suffering from a combination of stress incontinence and advanced cystocele.