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Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial

Trabuco, Emanuel C. MD, MS; Linder, Brian J. MD; Klingele, Christopher J. MD, MS; Blandon, Roberta E. MD, MS; Occhino, John A. MD, MS; Weaver, Amy L. MS; McGree, Michaela E. BS; Gebhart, John B. MD, MS

doi: 10.1097/AOG.0000000000002415
Contents: Original Research

OBJECTIVE: To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy.

METHODS: We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires. Overall continence was defined as a negative stress test, no retreatment for stress incontinence, and no self-reported urinary incontinence (International Consultation on Incontinence Questionnaire, Short Form, score, 0). Stress-specific continence was defined as fulfillment of the first two criteria and no self-reported stress-related incontinence. Primary outcomes were assessed with intention-to-treat and within-protocol analyses. Comparisons between groups were evaluated using χ2 or Fisher exact test.

RESULTS: The two groups were similar in all measured baseline features. Outcome assessments at 2 years were available for 48 of 57 patients (84%) in the sling group and 45 of 56 patients (80%) in the Burch group. With intention-to-treat analysis, the sling group had significantly higher rates of overall continence than the Burch group (49% [28/57] vs 29% [16/56]; 95% CI for absolute risk difference 3.0–38.1; P=.03) at 1- but not 2-year follow-up (47% [27/57] vs 32% [18/56]; 95% CI for absolute risk difference −2.6 to 33.1; P=.10). The sling group had significantly higher rates of stress-specific continence than the Burch group at 1-year (70% [40/57] vs 46% [26/56]; 95% CI for absolute risk difference 6.1–41.4; P=.01) and 2-year (70% [40/57] vs 45% [25/56]; 95% CI for absolute risk difference 7.9–43.2; P=.006) follow-up. No difference was detected in prolapse recurrence, voiding dysfunction, antimuscarinic medication use, urgency incontinence, or patient satisfaction.

CONCLUSION: Among women with baseline urinary incontinence undergoing sacrocolpopexy, the retropubic midurethral sling resulted in higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up.

With concomitant sacrocolpopexy, the retropubic midurethral sling has higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up (70% vs 46%).

Divisions of Gynecologic Surgery and Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and the Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Missouri.

Corresponding author: Emanuel C. Trabuco, MD, MS, Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; email: trabuco.emanuel@mayo.edu.

Supported by the Mayo Clinic Center for Clinical and Transitional Science grant number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the annual meeting of the International Urogynecological Association, Cape Town, South Africa, August 2–6, 2016.

The authors thank Scientific Publications, Mayo Clinic, for editing, proofreading, and reference verification and Amy L. Weaver and Michaela E. McGree for analyzing the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.