Introduction
Burch colposuspension treats stress urinary incontinence (SUI) in women. Dr. John C. Burch first described this surgery in 1961. It helps women who leak urine during activities like coughing, laughing, or exercising. Despite newer options, Burch colposuspension remains an important treatment choice for many women. This guide explains everything you need to know about this procedure.
What is Burch Colposuspension?
Burch colposuspension (also called the Burch procedure or retropubic urethropexy) fixes stress urinary incontinence. It works by lifting and supporting the bladder neck and urethra.
“The main idea behind Burch colposuspension is to put the bladder neck and urethra back where they belong,” explains Dr. Sophia Martinez, a urogynecologist. “By lifting these parts to their proper position, we help prevent urine leaks when pressure increases in your abdomen.”
The surgery uses strong stitches to connect the tissue near the bladder neck to Cooper’s ligaments (tough bands along the pelvic bone). These stitches lift and secure the vaginal tissue near the bladder and urethra. This makes it harder for urine to leak during activities that increase pressure in your abdomen.
History and Development
Doctors have searched for good treatments for female urinary incontinence for over a century. Dr. John C. Burch published his technique in 1961. It quickly became a leading treatment for SUI for decades.
Before Burch’s method, doctors used the Marshall-Marchetti-Krantz (MMK) procedure. This attached tissue near the urethra to the back of the pubic bone. Burch improved this approach by connecting the tissue to Cooper’s ligaments instead. This change reduced problems like pubic bone inflammation.
“Burch’s change was revolutionary because it worked just as well but caused fewer complications,” notes Dr. William Chen, Professor of Urology.
The procedure remained the gold standard until the late 1990s, when less invasive sling procedures became popular. Recently, interest in Burch colposuspension has grown again, especially after concerns about mesh-related problems with some sling procedures.
How the Surgery Works
Surgical Approaches
Surgeons can perform Burch colposuspension in different ways:
- Open (Traditional) Approach: Through a lower “bikini line” cut on the abdomen
- Laparoscopic Approach: Using several small cuts and a camera
- Robotic-Assisted Approach: An advanced form of laparoscopic surgery with better visibility and precision
Steps of the Procedure
The surgery follows these basic steps:
- The patient receives anesthesia
- The surgeon makes cuts based on the chosen approach
- The surgeon accesses the space behind the pubic bone
- The bladder is moved aside to see the front vaginal wall
- The surgeon finds Cooper’s ligaments along the pelvic bone
- Strong, permanent stitches connect the tissue near the bladder neck to Cooper’s ligaments on both sides
- These stitches are tightened to lift and support the bladder neck and urethra
- A camera check of the bladder ensures no damage has occurred
- The cuts are closed, and temporary drainage tubes may be placed
“The key to success is placing the stitches correctly with just the right tension,” explains Dr. Rebecca Thompson, a pelvic medicine specialist. “Too loose won’t fix the leaking, while too tight can make it hard to empty your bladder. Finding that balance takes significant surgical experience.”
Benefits and Success Rates
Burch colposuspension offers several advantages for treating stress urinary incontinence:
Effectiveness
Long-term studies show the lasting results of Burch colposuspension. According to research published in the European Urology Journal, cure rates one year after surgery range from 85-90%. About 70% of women remain dry at 5 years, and about 65% stay continent after 10 years.
“What makes Burch colposuspension so valuable is how long the results last,” states Dr. James Wilson, a urologist who specializes in female pelvic floor problems. “While no incontinence surgery lasts forever, Burch shows impressive staying power in the right patients.”
Other Benefits
Beyond fixing stress urinary incontinence, Burch colposuspension offers more advantages:
- It can be done at the same time as other abdominal surgeries like hysterectomy
- It doesn’t use synthetic mesh, avoiding mesh-related complications
- It helps restore normal anatomy by repositioning the bladder neck and urethra
Potential Risks and Complications
Like all surgeries, Burch colposuspension carries certain risks:
Surgical Risks
- General surgery risks: Problems with anesthesia, bleeding, infection, or damage to nearby structures
- Bladder injury: The bladder can be hurt during surgery because it’s close to the surgical area
- Urinary retention: Some patients have trouble emptying their bladder completely after surgery
After Surgery Complications
- New urinary urgency: Some women develop a sudden need to urinate after surgery
- Voiding problems: Changes in urine flow or incomplete bladder emptying can occur
- Return of incontinence: The procedure’s effectiveness may decrease over time
- Pelvic organ prolapse: Supporting one part of the pelvic floor can sometimes unmask weakness in other areas
“Careful patient selection and thorough counseling before surgery are essential to reduce complications,” advises Dr. Laura Reyes, a pelvic floor specialist. “While problems can occur, most are manageable. Serious issues are rare when experienced surgeons perform the procedure.”
Who is a Good Candidate?
Not all women with stress urinary incontinence should have Burch colposuspension. Several factors affect this decision:
Good Candidates Include:
- Women with stress urinary incontinence that significantly affects quality of life
- Patients who tried pelvic floor exercises and lifestyle changes without success
- Women already having abdominal surgery for other conditions who also have SUI
- Patients who prefer to avoid synthetic mesh materials
- Women whose urethra moves too much during physical activity
Less Suitable Candidates Include:
- Women with significant weakness of the urethral sphincter itself
- Patients who had failed incontinence procedures before
- Those with significant pelvic organ prolapse needing a different surgical approach
- Women who can’t handle general anesthesia or major surgery due to health issues
“Picking the right patient is perhaps the most important factor for surgical success,” emphasizes Dr. Michael Garcia, Chief of Urogynecology. “The ideal Burch candidate typically has a urethra that moves too much but has good sphincter function. Special testing can help identify these traits and guide proper treatment selection.”
Burch Colposuspension vs. Other Treatments
Understanding how Burch colposuspension compares to other options helps clarify its role in modern incontinence care:
Non-Surgical Treatments
Before considering surgery, doctors typically recommend:
- Pelvic Floor Physical Therapy: Guided exercises to strengthen pelvic floor muscles
- Lifestyle Changes: Weight loss, managing fluid intake, and bladder training
- Pessaries: Devices inserted into the vagina to support the bladder neck
“Non-surgical approaches should always be tried first for stress incontinence,” recommends Dr. Sarah Johnson, a women’s health physical therapist. “Many women see major improvement with dedicated pelvic floor rehabilitation, potentially avoiding surgery altogether.”
Other Surgical Options
Several surgical options compete with Burch colposuspension:
- Mid-Urethral Slings: TVT and TOT procedures place a thin strip of synthetic mesh under the mid-urethra. These less invasive procedures have largely replaced Burch as the first choice for many women.
- Autologous Fascial Slings: Uses the patient’s own tissue to create a supportive sling
- Bulking Agents: Injectable materials that increase urethral resistance
According to a 2017 review analyzing over 10,000 women across multiple studies, mid-urethral slings and Burch colposuspension work equally well at 5 years. Slings usually mean shorter hospital stays and recovery time. However, Burch may have fewer long-term complications related to mesh exposure or erosion.
“The choice between Burch and other procedures should be personalized,” advises Dr. Elizabeth Taylor, urologist and researcher. “Factors like patient anatomy, previous surgeries, other health conditions, and personal preferences all play important roles in making this decision.”
Recovery and After-Surgery Care
Recovery after Burch colposuspension requires attention to several aspects:
Hospital Stay and Early Recovery
- Hospital stay: Usually 1-3 days for open surgery; possibly shorter for laparoscopic approaches
- Catheter: A urinary tube typically stays in place for 1-7 days to rest the bladder
- Pain control: Prescribed medicines help manage discomfort
- Movement: Gradual return to activity starts with short walks
Recovery Timeline
- First 2 Weeks: Limited activity with focus on rest and healing
- 2-6 Weeks: Gradual increase in light activities
- 6-12 Weeks: Progressive return to normal activities, including exercise
- Full Recovery: Complete healing typically occurs by 3 months
“I tell my patients to be patient with their bodies during recovery,” says Dr. Patricia Wong, gynecologic surgeon. “While many women notice immediate improvement in their leaking, the full benefits may not be apparent until swelling goes down and tissues fully heal, which can take several weeks.”
Long-term Follow-up
Regular check-up appointments are essential to monitor:
- Resolution of incontinence symptoms
- How well the bladder empties
- Development of any complications
- Overall satisfaction with surgical results
Current Status and Future Trends
The role of Burch colposuspension has changed significantly over the past twenty years:
Current Role in Clinical Practice
While mid-urethral slings have become the most common surgical approach for stress urinary incontinence, Burch colposuspension maintains an important place:
- Primary Role: As an option for women having abdominal surgery for other reasons who also have SUI
- Alternative Role: For women who want to avoid synthetic mesh materials
- Specialized Role: For specific anatomical situations where this approach offers advantages
“We’ve seen renewed interest in Burch colposuspension following concerns about mesh complications with some sling procedures,” observes Dr. Robert Martinez, Chair of Urogynecology. “While not returning to its former status as the gold standard, the procedure has found its place in today’s practice.”
Innovations and Improvements
The basic Burch technique has seen several refinements:
- Less Invasive Approaches: Laparoscopic and robotic-assisted techniques have reduced recovery time
- Stitching Techniques: Variations in suture material, placement, and number have developed
- Combined Procedures: Integration with other pelvic floor repairs has expanded its use
Future Directions
Research continues to improve incontinence treatments:
- Patient Selection Tools: Better models to predict surgical outcomes
- Long-term Comparison Studies: Ongoing research comparing Burch to newer procedures over many years
- Technique Refinements: Continuing improvements in minimally invasive approaches
“The future of incontinence surgery lies in personalization,” predicts Dr. Amanda Richards, Director of Pelvic Floor Research. “As we gather more data on long-term results and develop better predictive tools, we’ll be able to match each patient with her ideal procedure based on individual factors. Burch colposuspension will continue to play an important role in this personalized approach.”
Frequently Asked Questions (FAQ)
What exactly is stress urinary incontinence?
Stress urinary incontinence (SUI) is the unwanted leakage of urine during activities that increase pressure in your abdomen. These include coughing, sneezing, laughing, or exercising. It happens when the pelvic floor muscles and tissues that support your bladder and urethra weaken. This allows urine to escape even when you’re trying to hold it.
How do I know if I’m a good candidate for Burch colposuspension?
Good candidates typically have stress urinary incontinence with a urethra that moves too much during activity. They should have tried non-surgical treatments without success and be in generally good health for surgery. Women planning to have more children or those with significant sphincter weakness may not be ideal candidates. A thorough evaluation by a specialist in female pelvic medicine is essential to determine if this procedure is right for you.
How long will the results of Burch colposuspension last?
Studies show that about 70% of women remain continent at 5 years after surgery, and about 65% stay dry at 10 years. However, individual results vary based on factors such as age, tissue quality, and following postoperative recommendations. Some women experience lasting results for 15-20 years or more.
What’s the difference between Burch colposuspension and a mid-urethral sling?
The main differences are in the surgical approach and materials used. Burch colposuspension is done through abdominal cuts (either open or laparoscopic) and uses stitches to lift and secure the tissues near the bladder neck to Cooper’s ligaments. Mid-urethral slings are typically less invasive procedures that place a synthetic mesh strip under the mid-urethra through small vaginal and/or abdominal cuts. Burch uses no permanent synthetic materials, while standard slings use mesh.
Will I have pain during sex after Burch colposuspension?
Most women do not experience pain during sex after healing from Burch colposuspension. However, any pelvic surgery carries a small risk of painful intercourse. Studies suggest that rates of sexual problems are generally low following Burch procedures compared to some other pelvic surgeries.
How soon can I return to work after surgery?
Return to work depends on the surgical approach and the physical demands of your job. Those with desk jobs may return within 2-4 weeks following an open procedure, or potentially sooner after laparoscopic approaches. Jobs requiring heavy lifting or strenuous physical activity may require 6-8 weeks of recovery time. Your surgeon will provide specific guidance based on your individual situation.
Can Burch colposuspension be performed if I’ve had previous pelvic surgeries?
Yes, Burch colposuspension can often be done despite previous pelvic surgeries. However, prior procedures may increase technical difficulty and slightly increase complication risks. Your surgeon will evaluate your surgical history as part of determining whether Burch is appropriate for your situation.
Is Burch colposuspension covered by insurance?
Most insurance plans, including Medicare, cover Burch colposuspension when medically necessary for treating stress urinary incontinence. However, coverage policies vary, so check with your insurance provider. Your healthcare provider’s office can typically help with insurance verification and pre-authorization if required.
Will I need a catheter after surgery, and for how long?
Most patients need a urinary catheter temporarily after Burch colposuspension. The duration varies based on surgeon preference and individual recovery, ranging from overnight to about one week. Some surgeons perform a voiding trial before discharge, while others may send patients home with a catheter to be removed at a follow-up visit.
What happens if the procedure doesn’t work for me?
If incontinence persists or returns after Burch colposuspension, other treatment options are available. These might include pelvic floor physical therapy, behavioral modifications, or alternative surgical procedures such as mid-urethral slings or bulking agents. Failed procedures don’t necessarily mean that subsequent treatments will be unsuccessful.
Conclusion
Burch colposuspension represents an important chapter in treating female urinary incontinence. While no longer the automatic first choice for most women with stress urinary incontinence, it remains valuable for certain patients. Its lasting legacy is seen in the countless women whose quality of life improved after the procedure.
As medical science advances our understanding of pelvic floor disorders and improves surgical techniques, Burch colposuspension stands as a proven procedure that has withstood the test of time. For women considering treatment for stress urinary incontinence, understanding all available options, including Burch colposuspension, empowers them to make informed decisions with their healthcare providers.