The efficacy of laparoscopic mesh colposuspension: results of a prospective controlled study

Objective To investigate the efficacy of laparoscopic mesh colposuspension as an equivalent approach to the 'gold standard' open Burch colposuspension . Patients and methods A prospective controlled study of laparoscopic mesh co lposuspension was conducted over 2 years: 87 patients with genuine stress i ncontinence (GSI) were recruited. The preoperative evaluation included a hi story, examination, midstream urine analysis, urinary voiding diary, a Uril os pad test, and twin-channel subtracted cystometry, including urethral pro filometry and measurement of the postvoid residual volume. The study includ ed patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients wer e assessed at 6 weeks. 6 months and I year after surgery and then yearly th ereafter. The urodynamic assessment was repeated 3 months after surgery. Results Forty-nine patients underwent laparoscopic colposuspension using Pr olene mesh and titanium tacks to elevate the bladder neck, while 38 patient s had open Burch colposuspension. There was no difference between the group s ill age, parity. body mass index. menopausal status, medical history. pre vious bladder neck surgery and prolapse. At 6 weeks the cure rate was simil arly high in the two groups (91% laparoscopic and 94% open). After a mean f ollow-up of 32 months, both groups showed it decline in efficacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, resp ectively (P < 0.05). Conclusion Laparoscopic colposuspension using a mesh and tacker technique r educes the technical difficulty and operating time of the endoscopic proced ure. but the long-term cure rates are inferior to open Burch colposuspensio n.