Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve...Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.展开更多
AIM： To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would signifcantly decrease subjective symptoms of stress urinary incon-tinence （SUI） and improve patient satisfaction.METH...AIM： To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would signifcantly decrease subjective symptoms of stress urinary incon-tinence （SUI） and improve patient satisfaction.METHODS： Women who underwent a combined sling removal and laparoscopic Burch procedure between 2009 and 2014 were matched via age and sling-type in a 1：2 ratio to women who only underwent a sling removal. Those who underwent surgery within 6 mo of data collection were excluded from the study, as were women who underwent multi-stage surgery. Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6 （UDI-6） and incontinence impact ques-tionnaire-7 （IIQ-7） per the standard clinical practice. All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard follow-up questions. Research staff contacted participants via email, mail, and telephone using the same questionnaire template and script. Data was analyzed by using c2 test for categorical data, and Student’s t test and Wilcoxon Rank Sum test for continuous data. The measure of effect was determined by logistic regression analysis.RESULTS： A total of 48 women out of 146 selected patients were successfully recruited with n = 22 in the Burch cohort and n = 26 in the control cohort. The mean age was 54.7 ± 7.8 years and mean body mass index was 22.0 ± 13.9 kg/m2. The majority of patients were Caucasian （73.3%）, postmenopausal （91.1%）, non-smokers （57.9%）, with a history of hysterectomy （81.4%）. Six nineteen point six percent of women presented after at least 2 years from placement, which was signifcantly more common in the Burch cohort. Pain was the most common chief complaint （64.4%） in both groups at the time of initial presentation, and 78.9% of women reported concomitant urinary incontinence. There was no signifcant difference in pre-operative UDI-6 and IIQ-7 scores between the two cohorts. However, the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of 28.41 points compared to a decrease of 4.01 points in the control group （P = 0.02, 95%CI： 3.84 to 44.97）.Although not statistically significant, the Burch cohort was 58% more likely to show an overall improvement in their score after surgery and 40% more likely to meet the minimal important difference of 11 points （RR = 1.58, 95%CI： 0.97 to 2.57; RR 1.40, 95%CI： 0.79 to 2.46）. The difference in IIQ scores was nonsignificant. There was no signifcant difference in blood loss, complications, or postoperative pain or dyspareunia.CONCLUSION： Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptom-related quality of life scores.展开更多
We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from Fe...We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.展开更多
文摘Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.
文摘AIM： To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would signifcantly decrease subjective symptoms of stress urinary incon-tinence （SUI） and improve patient satisfaction.METHODS： Women who underwent a combined sling removal and laparoscopic Burch procedure between 2009 and 2014 were matched via age and sling-type in a 1：2 ratio to women who only underwent a sling removal. Those who underwent surgery within 6 mo of data collection were excluded from the study, as were women who underwent multi-stage surgery. Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6 （UDI-6） and incontinence impact ques-tionnaire-7 （IIQ-7） per the standard clinical practice. All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard follow-up questions. Research staff contacted participants via email, mail, and telephone using the same questionnaire template and script. Data was analyzed by using c2 test for categorical data, and Student’s t test and Wilcoxon Rank Sum test for continuous data. The measure of effect was determined by logistic regression analysis.RESULTS： A total of 48 women out of 146 selected patients were successfully recruited with n = 22 in the Burch cohort and n = 26 in the control cohort. The mean age was 54.7 ± 7.8 years and mean body mass index was 22.0 ± 13.9 kg/m2. The majority of patients were Caucasian （73.3%）, postmenopausal （91.1%）, non-smokers （57.9%）, with a history of hysterectomy （81.4%）. Six nineteen point six percent of women presented after at least 2 years from placement, which was signifcantly more common in the Burch cohort. Pain was the most common chief complaint （64.4%） in both groups at the time of initial presentation, and 78.9% of women reported concomitant urinary incontinence. There was no signifcant difference in pre-operative UDI-6 and IIQ-7 scores between the two cohorts. However, the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of 28.41 points compared to a decrease of 4.01 points in the control group （P = 0.02, 95%CI： 3.84 to 44.97）.Although not statistically significant, the Burch cohort was 58% more likely to show an overall improvement in their score after surgery and 40% more likely to meet the minimal important difference of 11 points （RR = 1.58, 95%CI： 0.97 to 2.57; RR 1.40, 95%CI： 0.79 to 2.46）. The difference in IIQ scores was nonsignificant. There was no signifcant difference in blood loss, complications, or postoperative pain or dyspareunia.CONCLUSION： Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptom-related quality of life scores.
基金supported by the National Natural Science Foundation of China (81830043 and 81771561)the National Key Research and Development Program of China (2018YFC2002201)。
文摘We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.
