Alternatives to the Burch colposuspension

Abstract

MRCOG enuine stress incontinence is defined as the invol-untary loss of urine when the intravesical pressure G exceeds the maximum urethral closure pressure in the absence of detrusor activity.l It can affecz women of all ages and has a prevalence of lO-S@/o in women between the ages of 15 years and 64 years.' It can lead to embar-rassment, anxiety and, in some cases, social is~lation.~ Indeed, the management of patients with incontinence of all types has been the subject of a recent government paper.4 The Rurch colposuspension was first described in 1961 and is generally accepted as the 'gold standard' for the treatment of genuine stress incontinence. However, it is only one of many surgical approaches that have been described for the treatment of female genuine stress incontinence. This article examines alternatives to the Burch colposuspension. However, variations of the technique, such as laparoscopic Burch colposuspension, are not considered here. INITIAL ASSESSMENT As with most conditions in medicine, it is important to consider non-surgical approaches prior to subjecting a patient to an invasive and potentially dangerous procedure. When different treatments are considered, not only must the subjective and objective cure rates or improvements be assessed, but the effect of the treatment on the patient's quality of life must be mea~ured.~ A treatment 'that cures a patient but where the adverse effects result in a severe deterioration in quality of life is not justified. Lower urinary tract symptoms do not always COIddte with the urodynamic diagnosis. " Ideally, therefore, all patients should have an accurate urodynamic diagnosis prior to treatment; if this agrees with subjective symptonls, treatment is then instituted. This ideal becomes mandatory when the Alfred Cutner