Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Aug 10, 2016; 5(3): 210-217
Published online Aug 10, 2016. doi: 10.5317/wjog.v5.i3.210
Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life
Sarah A Huber, Orawee Chinthakanan, Soyini Hawkins, John R Miklos, Robert D Moore
Sarah A Huber, Soyini Hawkins, John R Miklos, Robert D Moore, International Urogynecology Associates, Alpharetta, GA 30005, United States
Orawee Chinthakanan, Department of Obstetrics and Gynecology, Bumrungrad International Hospital, Wattana Bangkok 10110, Thailand
Author contributions: Huber SA, Miklos JR and Moore RD designed the study; Huber SA and Hawkins S performed the research; Huber SA and Chinthakanan O analyzed the data; Huber SA and Moore RD wrote the paper and revised the manuscript for final submission.
Institutional review board statement: The study was reviewed and approved by the Sterling Institutional Review Board.
Informed consent statement: All involved persons enrolled in the study provided verbal and written informed consent prior to inclusion in the study.
Conflict-of-interest statement: The authors declare no conflicts-of-interest.
Data sharing statement: Technical appendix, original data, and statistical code are available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Robert D Moore, DO, International Urogynecology Associates, 3400 Old Milton Parkway, Alpharetta, GA 30005, United States.
Telephone: +1-770-4754499 Fax: +1-678-2623671
Received: March 26, 2016
Peer-review started: March 27, 2016
First decision: April 15, 2016
Revised: May 10, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 10, 2016

AIM: To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence (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 questionnaire-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 χ2 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%), nonsmokers (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 significantly 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 significant 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 significant 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.

Keywords: Mesh erosion, Burch urethropexy, Burch colposuspension, Anti-incontinence

Core tip: Performing a concomitant Burch urethropexy at the time of anti-incontinence mesh sling removal is safe and effective.