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Burch colposuspension using minimally invasive techniques

The Burch urethropexy, a routinely performed stress incontinence operation, was displaced by the advent of the popular minimally invasive sling. However, with controversy surrounding the use of vaginal mesh in women’s pelvic reconstructive surgery, both patients and physicians have renewed interest in pursuing the Burch urethropexy as a viable alternative to treat stress incontinence. The Burch procedure stabilizes the bladder neck as a means to restore continence. Variations of Dr. Burch’s technique have been developed over time with Dr. Tanagho’s modification as the most widely accepted method for suture location placement. Current technique typically includes permanent sutures placed lateral to the urethra and bladder neck which are then secured to the iliopectineal line (also known as Cooper’s ligament). Originally developed as an open technique, both laparoscopic and robotic approaches have negated the need for an incision. Success rates of the operation have been published for both abdominal and minimally invasive techniques. The procedure has been found to have similar success to minimally invasive outpatient sling procedures in the absence of clinical evidence of intrinsic sphincter deficiency. Although it has a somewhat longer operative time, the Burch procedure is a comparable outpatient surgery with good patient satisfaction and a low complication rate. This article will discuss the history behind the procedure, the laparoscopic technique, and provide recommendations to optimize results for the correction of stress incontinence.