Burch Colposuspension Vs. Fascial Sling for Urinary Stress Incontinence

In a multicenter trial 1 a total of 655 women with urinary stress incontinence were randomly assigned to pubovaginal sling group (using autologous rectus fascia) or to Burch colposuspension group. 520 women (79%) completed the outcome assessment. At 24 months, success rates for overall symptoms (negative pad test, no urinary incontinence in a 3-day diary, a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition) were higher in the sling group than in the Burch group (47% vs. 38%, P=0.01), and also for the latter three criteria, specific for stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence.

Comment: The quality of evidence is downgraded by study quality and by indirectness (quality of life not assessed).

References

• Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, Chai TC, Zyczynski H, Diokno AC, Tennstedt S, Nager C, Lloyd LK, FitzGerald M, Lemack GE, Johnson HW, Leng W, Mallett V, Stoddard AM, Menefee S, Varner RE, Kenton K, Moalli P, Sirls L, Dandreo KJ, Kusek JW, Nyberg LM, Steers W, Urinary Incontinence Treatment Network. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007 May 24;356(21):2143-55. [PubMed]