laparoscopic burch colposuspension done for sui

1. Laparoscopic Burch Colposuspension:
Our Early Experience
Dr Anamika Jha
Fellow Urogynecology
10/2/2024

2. Contents
• Introduction
• Classification
• Surgical management and complications
• Our experience
• References

3. • Burch colposuspension is an operation used to treat Stress Urinary
Incontinence(SUI).
• SUI- Involuntary leakage of urine on effort or exertion or sneezing or
coughing(ICS).
Incidence:
• Urinary incontinence - 30% to 40%.
• SUI - the most common form of urinary incontinence in women
(50%) .

4. Pathophysiology
• In a continent individual, increased abdominal pressure is evenly
distributed over the bladder, bladder neck, and urethra, allowing the
urethra to withstand the pressure and maintain continence.
• In a person with pure stress urinary incontinence, either the urethra is
hypermobile or the sphincter is intrinsically deficient.

5. • In urethral hypermobility, the urethral vesicular junction (UVJ) is
displaced extra-abdominally, and the increased intra-abdominal pressure
is unevenly distributed such that the sphincter can no longer withstand the
pressure and urine leaks.
• With intrinsic sphincter deficiency (ISD), the UVJ is not hypermobile;
however, the maximal urethral closing pressure, the Valsalva leak-point
pressure, or both are too low to withstand the increase in intra-abdominal
pressure and, thus, urine leaks past the sphincter.

6. Blaivas Classification of stress incontinence:
• Type 1: anatomical, due to hypermobility of the urethrovesical angle
• Type 2: rotational descent of the bladder base
• Type 3: intrinsic sphincter deficiency (ISD)

7. Operations for SUI
When non-surgical management for stress urinary incontinence has
failed, and the woman wishes a surgical procedure, :
• Colposuspension (open/laparoscopic/robotic)
• Autologous rectus fascial sling
• Retropubic mid-urethral mesh sling (TOT/TVT)
NICE GUIDELINE 2019

8. Principles of surgery
• Restoration of normal anatomy to maintain bladder neck and proximal
urethra as intra-abdominal structures.
• Strengthening support of bladder neck and proximal urethra
preventing funneling of vesicourethral junction in response to
intravesical pressure.
• To increase functional urethral length

9. Retropubic Colposuspension Surgeries
• The modern era of retropubic surgery for stress incontinence began in
1949, when Marshall et al. described their technique for urethral
suspension in a man with post prostatectomy incontinence.
• several modifications of this operation has been done.
• This procedure is performed suprapubically (through low abdominal
incision) to reach the space of Retzius.

10. Retropubic Colposuspension Surgeries
• Based on “Delancey’s Hammock Theory”
• Marshall–Marchetti–Krantz (MMK):(1949)
endopelvic fascia fixed to periostuem of
symphysis pubis: obsolete
• Burch procedures: (1961) periurethral
tissue fixed to Cooper’s ligament
• Can be done via Open or laparoscopic
method

11. Technique of Burch colposuspension

14. Vaginal cuff and bilateral adnexa are identified.
Retrograde filling of bladder to identify its margins.
Parietal peritoneum is retracted posteriorly away from the anterior abdominal
wall.
Peritoneum is entered to access the space of Retzius.
Space of Retzius is a potential space and opens with the help of
pneumodissection from the insufflated abdomen.
Procedure

15. • Dissection down to the level of Cooper ligaments is performed, with the
urethra, ureterovesical junction and the lower margin of the bladder all being
exposed.
• Placement of a finger or vaginal manipulator into the vagina can help with
identification of the borders of the vaginal walls.
• Suspension sutures are placed; suture should pass through the endopelvic
fascia and vagina without entering the vaginal epithelium; to help with suture
placement, an assistant has a finger on vagina, placing upward pressure on
the anterior vaginal wall.
• Sutures are brought up to Cooper ligament on the ipsilateral side and tied.

17. • Successful outcome following colposuspension: 85-90% at 1 year and
70% at 20 years.
• A recent 2017 Cochrane review showed that Burch and other
retropubic colposuspension procedures has a long-term (5 years or
more) success rates of around 70% .
• Compared to pubovaginal slings, open colposuspension is associated
with a lower risk of voiding dysfunction, but with a higher risk of
subsequent pelvic organ prolapse.

18. Complications
• Short term complications
Intra operative vascular injury, bladder and urethral injury
Infections
Voiding difficulties
• Long term complications
De novo detrusor overactivity(14 - 17%)
Posterior vaginal wall prolapse(14 - 49%)
Vault or cervical prolapse(42%)
Dyspareunia (2-5%)
Recurrent UTI (4.5%)
Erosion of non-absorbable sutures

19. Cases done in KMH in 2023
• TOT-15
• Laparoscopic Burch Colposuspension-18

20. Complications
• Failed surgery- 2
(Neurogenic Bladder -1d/t DM-2:Hematoma and infection in Burch
sutures)
• Bladder injury -2
• Port site infection-3
• Urinary retention -1

21. References
• Walters MD.Karram MM.Urogynecology and Reconstructive Pelvic
Surgery.4th edition.USA:Elsevier;2007
• Berek JS. Berek and Novak’s gynecology. 15th ed. USA: Lippincott
Williams and wilkins; 2012
• Hoffman BL,Schorge JO,Bradshaw KD,Halvorson LM,Schaffer JI,Corton
MM.Wiliams Gynaecology.new york,USA:McGraw-Hill
Education;2016.Chapter 23,Urinary incontinence;p.514-37.
• Abrams P, ArtibaniW, Cardozo L, Khoury S,Wein A.Clinical Manual of
Incontinence in women-based on reports of 3rd international consultation
on continence.21sted.Paris, France: Health publications Ltd ;2005
• Cardazo L.Staskin D.Textbook of Female Urology and Urogynecology.5th
edition.