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Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial.
Obstet Gynecol. 2018 01; 131(1):31-38.OG

Abstract

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 χ 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.

Links

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Authors+Show Affiliations

Trabuco EC
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.
Linder BJ
No affiliation info available
Klingele CJ
No affiliation info available
Blandon RE
No affiliation info available
Occhino JA
No affiliation info available
Weaver AL
No affiliation info available
McGree ME
No affiliation info available
Gebhart JB
No affiliation info available

MeSH

AgedColposcopyFemaleFollow-Up StudiesHumansMiddle AgedPatient SatisfactionQuality of LifeRisk AssessmentSeverity of Illness IndexSingle-Blind MethodSuburethral SlingsSurgical MeshTime FactorsTreatment OutcomeUrethraUrinary Incontinence, StressUrinary Incontinence, UrgeUrodynamicsUrologic Surgical Procedures

Pub Type(s)

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

Language

eng

PubMed ID

29215517

Clinical Trial Links

Clinical trial which this article describes

Citation

Trabuco, Emanuel C., et al. "Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: a Randomized Controlled Trial." Obstetrics and Gynecology, vol. 131, no. 1, 2018, pp. 31-38.
Trabuco EC, Linder BJ, Klingele CJ, et al. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol. 2018;131(1):31-38.
Trabuco, E. C., Linder, B. J., Klingele, C. J., Blandon, R. E., Occhino, J. A., Weaver, A. L., McGree, M. E., & Gebhart, J. B. (2018). Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstetrics and Gynecology, 131(1), 31-38. https://doi.org/10.1097/AOG.0000000000002415
Trabuco EC, et al. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: a Randomized Controlled Trial. Obstet Gynecol. 2018;131(1):31-38. PubMed PMID: 29215517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. AU - Trabuco,Emanuel C, AU - Linder,Brian J, AU - Klingele,Christopher J, AU - Blandon,Roberta E, AU - Occhino,John A, AU - Weaver,Amy L, AU - McGree,Michaela E, AU - Gebhart,John B, PY - 2017/12/8/pubmed PY - 2018/1/9/medline PY - 2017/12/8/entrez SP - 31 EP - 38 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 131 IS - 1 N2 - 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 χ 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. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/29215517/Two_Year_Results_of_Burch_Compared_With_Midurethral_Sling_With_Sacrocolpopexy:_A_Randomized_Controlled_Trial_ DB - PRIME DP - Unbound Medicine ER -