Burch colposuspension and the pelvic floor

Abstract: The Burch colposuspension is a surgical method for treatment of stress urinary incontinence, which has become popular due to a high cure-rate. A number of patients, however, develop recurrent urinary incontinence after the colposuspension, or other disabling conditions, such as genital prolapse or voiding difficulties.The study material consists of 243 women with stress urinary incontinence operated on with Burch colposuspension during 1980-88, 57 women with primary stress urinary incontinence assessed during 1991-93, and 16 healthy continent female volunteers.The aims of the study were to investigate the long-term results of the Burch colposuspension, to evaluate the occurrence of genital prolapse and neuropathy in the pelvic floor muscles in relation to the outcome of Burch colposuspension with regard to urinary continence, and to evaluate whether defecography, anorectal manometry and gynecological examination could predict the development of genital prolapse demanding surgery after Burch colposuspension.The study shows that the short-term cure-rate of the Burch colposuspension was high, 95.6%. Median 6 years after the operation 63% were subjectively continent. A further 27% of the women were improved. Prognostic factors for an unsuccessful outcome were immediate and long-tetm voiding difficulties postoperatively, postoperative febrile morbidity, recurrent lower urinary tract infections and previous anti-incontinence operations. After the colposuspension, 15% of the women had been operated on for posterior vaginal wall prolapse.Women, who have recurrent stress urinaty incontinence, seem to have a more pronounced pelvic floor weakness, demonstrated as a higher incidence of rectocele and cystocele, and neurogenic EMG patterns in more muscles in the pelvic floor, than women who are continent after Burch colposuspension.The preoperative gynecological examination, the defecography and the anorectal manometry do not seem to be able to predict the development of genital prolapse demanding surgery after Burch colposuspension.The associations between the occun·ence of genital prolapse and neurogenic EMG patterns, respectively, and the outcome of the Burch colposuspension with respect to continence, demonstrated in the present study, might support the theory that neuromuscular changes in the pelvic floor are contributing factors for the development of recurrent urinary incontinence and genital prolapse after Burch colposuspension. The etiology of recurrent urinary incontinence and urogenital prolapse seems to be multifactorial. Larger prospective studies are however needed to solve the important problems concerning the influence of the neuromuscular function of the pelvic floor on the outcome of anti-incontinence surgery and on the development of genital prolapse.