Introduction
Millions of people worldwide deal with urinary incontinence, with women being affected most often. Burch colposuspension is one of the oldest and most tested surgeries for stress urinary incontinence (SUI). Dr. John Christopher Burch first described this method in 1961. Since then, the technique has improved while staying a gold standard against which doctors compare newer treatments.
This guide will walk you through everything you need to know about Burch colposuspension. We’ll cover how it works, who should get it, recovery time, success rates, and how it compares to other options. Whether you’re thinking about this surgery or just want to learn more, this guide offers clear, fact-based info to help you understand this important treatment.
What is Burch Colposuspension?
Burch colposuspension (also called retropubic urethropexy) is a surgery that treats stress urinary incontinence in women. SUI happens when actions like coughing, sneezing, running, or lifting cause you to leak urine.
This surgery lifts and secures the tissues near your bladder neck and urethra back to where they should be. This helps your bladder work normally by giving better support to these areas, which may have weakened after childbirth, aging, or other causes.
How It Works
During Burch colposuspension, the surgeon places permanent stitches between the vaginal wall (near where it meets the urethra) and the iliopectineal ligament (Cooper’s ligament) on the pelvic bone. These stitches lift and support the urethra and bladder neck, which helps stop urine leakage during physical activities.
Historical Context
The Burch procedure has a rich history in women’s health:
- 1961: Dr. John Burch first describes the method
- 1970s-1990s: Becomes the gold standard for SUI treatment
- 2000s: Faces competition from newer sling procedures but stays important
- Today: Still useful as both a first-choice and backup option
For decades, doctors considered Burch colposuspension the best surgical fix for SUI. Studies reported 70-90% cure rates that lasted many years. While newer methods like midurethral slings are more common now, Burch colposuspension remains a valuable option for doctors who treat women with bladder control issues.
Who Can Get Burch Colposuspension?
Doctors may suggest Burch colposuspension for women who:
- Have stress urinary incontinence that hasn’t improved with exercise or other treatments
- Need other pelvic surgeries at the same time, like hysterectomy
- Had other incontinence surgeries that didn’t work
- Have a urethra that moves too much (urethral hypermobility)
- Don’t want mesh implants (used in some sling procedures)
- Are younger and might want to have children later
The best candidates are generally healthy women who have realistic hopes for the outcome. They should have proper testing before surgery to confirm they truly have stress urinary incontinence.
The Surgical Procedure
Surgeons can perform Burch colposuspension in different ways. Each approach has its own pros and cons.
Open Approach
The traditional open Burch colposuspension involves:
- Making a cut in the lower belly (like a C-section cut)
- Accessing the space behind the pubic bone
- Finding the bladder neck and urethra
- Placing permanent stitches between the vaginal wall and Cooper’s ligament on both sides
- Tying the stitches to create the right lift and support
- Closing the cut in layers
This approach gives the surgeon a clear view but needs a larger cut and longer healing time.
Laparoscopic Approach
The laparoscopic Burch follows similar steps but uses several small cuts, special tools, and a camera system. This less invasive approach usually offers:
- Less blood loss
- Shorter hospital stay
- Faster recovery
- Less pain after surgery
- Smaller scars
Studies show success rates are similar between open and laparoscopic methods when done by skilled surgeons.
Robotic-Assisted Approach
More recently, robotic-assisted laparoscopic Burch colposuspension has become an option, offering:
- Better precision and viewing
- More comfort for the surgeon
- Easier learning curve for surgeons who know robotic systems
The choice between these approaches depends on the surgeon’s skills, the patient’s needs, hospital resources, and whether other procedures will happen at the same time.
Before Surgery: Preparation and Testing
Before getting Burch colposuspension, patients typically have:
Diagnostic Testing
- Urodynamic studies: Tests that confirm SUI and rule out other types of incontinence
- Cystoscopy: Exam of the bladder and urethra using a thin, lighted scope
- Voiding diary: Record of bathroom visits and leakage episodes
- Pad test: Measures how much urine leaks
- Q-tip test: Checks how much the urethra moves
Preoperative Preparation
- Standard blood work and physical exam
- Testing for and treating any urinary tract infections
- Talk about changing medicines (especially blood thinners)
- Possible bowel prep
- Instructions about when to stop eating before surgery
Recovery Process
Recovery from Burch colposuspension varies based on the surgical approach and personal factors. Here’s what to expect:
Hospital Stay
- Open procedure: 2-3 days
- Laparoscopic/robotic: 1-2 days or sometimes same-day discharge
Right After Surgery
- Urinary catheter for 1-2 days
- Pain control with medicines
- Walking soon after surgery
- Watching for any problems
First Few Weeks
- Slow return to light activities
- No heavy lifting (more than 10 pounds)
- Pelvic floor exercises as directed
- Driving again after 1-2 weeks (when no longer taking strong pain meds)
Long-term Recovery
- Full recovery within 4-6 weeks for laparoscopic surgeries
- Up to 12 weeks for open surgeries
- Sex usually okay after 6 weeks
- Return to full exercise and hard activities after 8-12 weeks
Success Rates and Outcomes
Burch colposuspension has shown strong long-term results in many studies:
Success Rates
- Short-term (1-2 years): 85-90% success
- Medium-term (5 years): 70-80% success
- Long-term (10+ years): 65-70% success
A major study in the New England Journal of Medicine (2007) found that two years after surgery, Burch colposuspension had a 66% success rate. This compared to 47% for bladder neck sling procedures.
What Affects Success
Several factors can change your outcome:
- Surgeon’s experience and technique
- Your age and weight
- Previous pelvic surgeries
- How severe and long-lasting your incontinence was
- Whether you have mixed incontinence symptoms
- Following recovery instructions
Risks and Complications
Like any surgery, Burch colposuspension has certain risks:
Common Complications
- Temporary trouble emptying your bladder (5-20%)
- Urinary tract infections (5-10%)
- Wound infection or healing issues (2-5%)
- Pain during recovery (varies)
- New urgency symptoms (5-17%)
Less Common Complications
- Bladder injury (1-5%)
- Bleeding that needs a transfusion (<2%)
- Long-term catheter use due to voiding problems (<2%)
- Stitches eroding into tissue (rare)
- Pelvic organ prolapse in a different area (5-15% over time)
Long-term Considerations
- Possible return of incontinence over time
- May need more procedures later
- Impact on future pelvic surgeries
Comparing Burch Colposuspension to Other Options
Several treatments exist for stress urinary incontinence, each with different pros and cons:
Non-Surgical Options
- Pelvic floor physical therapy: First treatment to try; no surgical risks but might not work for severe cases
- Pessaries: Removable devices that support the urethra; easy but need regular care
- Bulking agents: Injectable materials to support the urethra; minimal invasion but often don’t last
- Medications: Limited help for pure stress incontinence
Surgical Options
- Midurethral slings (MUS): Now the most common surgery; shorter operation with similar success rates but uses synthetic mesh
- Pubovaginal slings using your own tissue: Good for those who want to avoid synthetic materials
- Marshall-Marchetti-Krantz procedure: Similar to Burch but attaches to the pubic bone; more bone pain
- Artificial urinary sphincter: Used for complex or repeat cases
How They Compare
A 2017 review comparing open Burch colposuspension to tension-free vaginal tape found:
- Similar effectiveness at 1-5 years
- Slightly more complications but fewer repeat surgeries with Burch
- Longer operation time and hospital stay with Burch
A key benefit of Burch colposuspension is that it doesn’t use mesh. Some patients who got midurethral slings have had mesh-related problems.
Special Cases
Burch Colposuspension During Other Surgeries
Doctors can perform Burch colposuspension along with other pelvic surgeries:
- During abdominal hysterectomy
- During sacrocolpopexy for pelvic organ prolapse
- During other abdominal surgeries when incontinence exists
Studies suggest that doing preventive Burch colposuspension during prolapse surgery may lower the risk of developing stress incontinence afterward in high-risk women.
Pregnancy After Burch
For younger women who may want future pregnancies:
- Burch colposuspension may be better than mesh procedures
- Pregnancy is generally safe after healing from Burch
- Vaginal delivery may affect long-term success
- Talk with your doctor about delivery options
Current Medical Guidelines
Major medical groups have given guidance on using Burch colposuspension:
- The American Urological Association (AUA) recognizes it as a standard treatment
- The American College of Obstetricians and Gynecologists (ACOG) recommends it, especially for women having abdominal surgery for other reasons
- The International Continence Society (ICS) acknowledges it as effective with long-term data supporting its use
These groups stress the importance of thorough testing before surgery and making treatment decisions based on each patient’s needs.
Recent Improvements
Surgeons have suggested several changes to the classic Burch technique:
- Fewer stitches (two instead of four)
- Different stitch materials
- Various ways to adjust tension
- Single-cut laparoscopic approaches
Research continues to refine the procedure for best results with minimal complications.
Life After Burch Colposuspension
Most patients report high satisfaction after successful Burch colposuspension. Many women see big improvements in quality of life. They often report:
- More confidence in social settings
- Return to exercise and physical activities
- Better sex life
- Less need for pads
- Better sleep with fewer nighttime bathroom trips
Keeping up with pelvic floor exercises and managing weight can help maintain surgical results.
Frequently Asked Questions
How long does a Burch colposuspension last?
Research shows that Burch colposuspension provides lasting results. Success rates of 65-70% continue even after 10+ years. Some women stay continent for life after the procedure. Others may have symptoms return as they age or if they gain a lot of weight.
Will I need a catheter after surgery?
Yes, most patients need a urinary catheter for 1-2 days after surgery. Some may need it longer if they have trouble emptying their bladder. Your surgeon will give you specific instructions about catheter care and removal.
How soon can I return to work after surgery?
Return to work depends on your job and surgical approach:
- Desk jobs: 2-3 weeks after laparoscopic surgery; 4-6 weeks after open surgery
- Physical jobs: 8-12 weeks
Does insurance cover Burch colposuspension?
Most insurance plans cover Burch colposuspension when medically needed for proven stress urinary incontinence. You’ll likely need prior approval, and coverage depends on your specific plan. Medicare and Medicaid generally cover it when proper documentation shows it’s medically necessary.
Can Burch colposuspension be reversed?
Technically, surgeons can reverse the procedure by cutting the stitches. This rarely happens except for serious complications like urinary retention. Reversal becomes harder over time as tissue scarring occurs.
What happens if the procedure doesn’t work?
If Burch colposuspension fails to fix incontinence symptoms, you have several options:
- More testing to find specific issues
- Pelvic floor physical therapy
- Other surgical approaches like midurethral slings
- Bulking agent injections
- Sacral neuromodulation for mixed symptoms
Conclusion
Burch colposuspension remains an important option for women with stress urinary incontinence. It’s especially good for those who want to avoid synthetic mesh or who are having other abdominal surgery. Despite newer, less invasive procedures, its long track record of success and safety keeps it relevant today.
The decision to have Burch colposuspension should come after thorough testing and talks with a qualified specialist. They can explain the benefits, risks, and alternatives based on your specific situation. With proper patient selection and surgical technique, this procedure continues to help many women who suffer from stress urinary incontinence.