Burch procedure compared with sling for stress urinary incontinence: A decision analysis

Objective: To compare the relative risks and benefits of Burch colposuspens ion and sling procedure for primary genuine stress urinary incontinence in women. Methods: We developed a decision analytic model to compare Burch procedure and sling for primary surgical treatment of genuine stress incontinence wit h urethral hypermobility in women. Risks and benefits were estimated from p ublished literature. The main outcome measure was effectiveness of treatmen t, defined as cure of incontinence after initial and secondary treatments. We considered four outcomes of primary surgical treatment: cure, persistent incontinence (either caused by intrinsic sphincter deficiency without uret hral hypermobility or genuine stress incontinence with hypermobility), de n ovo detrusor instability, and permanent urinary retention. Secondary treatm ent included repeated surgery for genuine stress incontinence, collagen inj ection for intrinsic sphincter deficiency, medical treatment for detrusor i nstability, and urethrolysis for retention. One-way sensitivity analyses we re used to estimate the effect of varying each characteristic through its r ange; all other characteristics were fixed at their baseline values. Results: The overall effectiveness of Burch and sling operations (percentag es of women cured after initial and secondary treatments) was similar (94.8 % and 95.3%, respectively). In sensitivity analyses, the Burch arm of the m odel was more effective than sling when the risk of retention after sling w as higher than 9.0% or when the risk of de novo detrusor instability after sling was higher than 10.3%. Conversely, when the risk of de novo detrusor instability after Burch was higher than 6.8%, the sling arm of the model wa s more effective. Conclusion: The Burch and sling procedures are similarly effective for prim ary surgical treatment of genuine stress incontinence in women. Overall eff ectiveness is substantially influenced by relative rates of complications. (Obstet Gynecol 2000;96:867-73. (C) 2000 by The American College of Obstetr icians and Gynecologists.).