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Burch colposuspension versus fascial sling to reduce urinary stress incontinence.
N Engl J Med. 2007 May 24; 356(21):2143-55.NEJM

Abstract

BACKGROUND

Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations.

METHODS

We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events.

RESULTS

A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence.

CONCLUSIONS

The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .).

Authors+Show Affiliations

Division of Urology, University of California, San Diego, San Diego, CA 92103-8897, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17517855

Citation

Albo, Michael E., et al. "Burch Colposuspension Versus Fascial Sling to Reduce Urinary Stress Incontinence." The New England Journal of Medicine, vol. 356, no. 21, 2007, pp. 2143-55.
Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143-55.
Albo, M. E., Richter, H. E., Brubaker, L., Norton, P., Kraus, S. R., Zimmern, P. E., Chai, T. C., Zyczynski, H., Diokno, A. C., Tennstedt, S., Nager, C., Lloyd, L. K., FitzGerald, M., Lemack, G. E., Johnson, H. W., Leng, W., Mallett, V., Stoddard, A. M., Menefee, S., ... Steers, W. (2007). Burch colposuspension versus fascial sling to reduce urinary stress incontinence. The New England Journal of Medicine, 356(21), 2143-55.
Albo ME, et al. Burch Colposuspension Versus Fascial Sling to Reduce Urinary Stress Incontinence. N Engl J Med. 2007 May 24;356(21):2143-55. PubMed PMID: 17517855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Burch colposuspension versus fascial sling to reduce urinary stress incontinence. AU - Albo,Michael E, AU - Richter,Holly E, AU - Brubaker,Linda, AU - Norton,Peggy, AU - Kraus,Stephen R, AU - Zimmern,Philippe E, AU - Chai,Toby C, AU - Zyczynski,Halina, AU - Diokno,Ananias C, AU - Tennstedt,Sharon, AU - Nager,Charles, AU - Lloyd,L Keith, AU - FitzGerald,MaryPat, AU - Lemack,Gary E, AU - Johnson,Harry W, AU - Leng,Wendy, AU - Mallett,Veronica, AU - Stoddard,Anne M, AU - Menefee,Shawn, AU - Varner,R Edward, AU - Kenton,Kimberly, AU - Moalli,Pam, AU - Sirls,Larry, AU - Dandreo,Kimberly J, AU - Kusek,John W, AU - Nyberg,Leroy M, AU - Steers,William, AU - ,, Y1 - 2007/05/21/ PY - 2007/5/23/pubmed PY - 2007/5/30/medline PY - 2007/5/23/entrez SP - 2143 EP - 55 JF - The New England journal of medicine JO - N Engl J Med VL - 356 IS - 21 N2 - BACKGROUND: Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations. METHODS: We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events. RESULTS: A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence. CONCLUSIONS: The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/17517855/Burch_colposuspension_versus_fascial_sling_to_reduce_urinary_stress_incontinence_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa070416?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -