腹腔镜下阴道悬吊术：经腹腔的方法（图文演示）

10. Results

Results
Comparisons of the open Burch technique with other frequently used ones have been carried out. A randomized study of Bergman (Bergman and Elia, 1995) compares the results of Burch colposuspension, modified Peyrera needle suspension, and Kelly plication at 1-year and 5-year post-procedure, with a higher cure rate for the Burch technique. Objective criteria were used (absence of stress urinary incontinence).

A British study (Alcalay et al., 1995) cites a 69% cure rate for the Burch technique 10 to 12 years after the procedure. In laparoscopic colposuspension, the use of 2 single-bite sutures on each side of the urethra seems to have better results than 1 double-bite suture on each side (Persson and Wolner-Hanssen, 2000).
For some authors, the results of the laparoscopic Burch procedure are less favorable. In a randomized study of 100 patients, McDougall (1999) compared the laparoscopic Burch technique to the transvaginal colposuspension of Raz. With a 45-month follow-up, McDougall reported a 30% cure rate for the Burch technique, as compared to a 35% cure rate for the Raz technique.
Long-term complications include voiding difficulty with a risk of recurrent urinary tract infection and de novo detrusor instability (Alcalay et al., 1995). The existing risk of subsequent rectocele or colpocele has led certain authors to combine colposuspension with a transvaginal myorrhaphy of the levator ani muscles.

Conclusion
Burch colposuspension has proven to be effective in treating stress urinary incontinence. When performed laparoscopically, the patient benefits from minimal postoperative pain and decreased hospital stay.
Because it is difficult to objectively assess results pertaining to urinary incontinence, long-term results remain subject for debate.
Several randomized studies comparing the laparoscopic Burch technique and tension-free vaginal tape insertion are currently underway. They should provide new criteria for choosing treatments for stress urinary incontinence.

11. Reference

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Alcalay M, Monga A, Stanton SL. Burch colposuspension: a 10-20 year follow up. Br J Obstet Gynaecol
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Bergman A, Elia G. Three surgical procedures for genuine stress incontinence: five-year follow-up of a
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Bruhat MA, Glowaczower E, Raiga J, Wattiez A, Pouly JL, Canis M, Mage G. Coeliochirurgie Encycl Méd
Chir (Paris-France), Gynécologie, 71-A-10, 1995 16p.
Burch JC. Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele and
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McDougall EM, Heidorn CA, Portis AJ, Klutke CG. Laparoscopic bladder neck suspension fails the test of
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Persson J, Wolner-Hanssen P. Laparoscopic Burch colposuspension for stress urinary incontinence: a
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Saidi MH, Gallagher MS, Skop IP, Saidi JA, Sadler RK, Diaz KC. Extraperitoneal laparoscopic
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Burch colposuspension. Obstet Gynecol 1998;92:619-21.
Vancaillie TG, Schuessler W. Laparoscopic bladderneck suspension. J Laparoendosc Surg 1991;1:169-
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