COMPARISON OF TWO DIFFERENT SURGICAL APPROACHES IN THE TREATMENT OF STRESS URINARY INCONTINENCE: OPEN AND LAPAROSCOPIC BURCH COLPOSUSPENSION

Introduction: Open Burch colposuspension has long been the standard surgical approach to stress urinary incontinence (SUI) secondary to urethral hypermobility. In 1991, Vancaillie and Schuessler reported for the first time that open Burch colposuspension could be performed endoscopically by some modifications. Thereafter, others described improvements using strapler, tacker and synthetic mesh in order to increase the efficacy of the surgery and to shorten the duration of laparoscopic approach. This study is therefore aimed to compare open Burch colposuspension with the laparoscopic Burch colposuspension performed with mesh and bone fixator in terms of cost-effectivity, the success and complication rates. Materials and Methods: 60 patients with primary stress urinary incontinence were randomized to either laparoscopic (n=27, group 1) or open Burch colposuspension (n=33, group 2) between December 2000 and October 2004. In order to approximate paravaginal tissue to the Cooper's ligament, mesh and tacker were used in the laparoscopic group and 2-0 polyglactin suture in the open group. The success rates in the first and third postoperative years and factors affecting morbidity were investigated. Complete cure was considered when the patient did not need any pad postoperative. Intraoperative and postoperative complications, length of the operation, quantity of blood loss, length of hospital stay, time to return daily activities, and postoperative analgesic use were determined. These factors and cost effectivity were compared in both groups. Results: Group1 and 2 were followed up for 38.7 +/- 10.2 months and 42.12 +/- 13.8 months, respectively. At the end of the first year, the success rates for group1 and group 2 were 85% (23/27) and 90% (30/33), respectively (p>0.05). These rates declined to 51.85% (14/27) for group 1 and to 72.72% (24/33) for group 2 at the third year, respectively (p>0.05). The rate of complications was low in both groups. Two intraoperative complications (bladder perforation in 1 patient, subcutaneous emphysema in 1) was observed in group1 and three postoperative complications (transient urinary retention in 2 patients in group 1 and in 1 patient in group 2) were encountered. The duration of hospital stay, postoperative analgesic (diclophenac sodium) need, time to return normal daily activities, time to postoperative catheter extraction, time to perivesical drainage catheter, average blood loss, average duration of the surgery were found 1.7 +/- 1.1 days and 4.6 +/- 0.7 days (p<0.05), 111.1 +/- 38.6 mg and 316.6 +/- 59.8 mg (p<0.05), 13.3 +/- 1.8 days and 35.5 +/- 4.6 days (p<0.05), 1.3 +/- 0.8 days and 4.3 +/- 0.8 days (p<0.05), 1.3 +/- 0.5 days and 3.6 +/- 0.5 days (p<0.05), 100 +/- 11.54 cc and 144.5 +/- 21.04 cc (p<0.05), 87.03 +/- 17.8 minutes and 60 +/- 7.7 minutes (p<0.05) for group 1 and group 2, respectively. The mean operation cost was calculated as 1920 $ and 852 $ for group 1 and group 2, respectively. Conclusion: Laparoscopic Burch colposuspension has been described as a minimal invasive approach in the treatment stress urinary incontinence. But we think that open Burch colposuspension should be preferred to instead of laparoscopic approach because of declining success rate during following in laparoscopic group and its high cost.