Female incontinence surgeries - Sling Vs Burch

Researchers from the University of California, San Diego conducted a “Burch Vs Sling” method’s study with female patients having incontinence problems and declared the latter to be a more effective method to contain the problem, as published in the online edition of the New England Journal of Medicine (NEJM).

The tests, sponsored by the National Institutes of Health (NIH), were conducted to compare two types of surgeries, the pubovaginal sling (commonly known as the sling procedure), and the Burch colposuspension (commonly called the Burch procedure), that are the most commonly used methods to correct the problem of incontinence which usually occurs in women after pregnancy or menopause causing an involuntary and non-deliberate urine leakage during coughing, sneezing, laughing, exercise or any other physical activity that pressurizes the bladder.

In the sling procedure doctors use a strip of the patients own muscle or tissue to stabilize the bladder and provide support to the urine tube.

The Burch procedure involves tying the urine tube or part of the bladder using sutures to the surrounding pelvic ligaments.

The research team comprising of urologists and urogynecologists led by Dr Michael Albo of the Division of Urology, University of California, San Dieg conducted clinical trials on 655 women randomly in different hospitals and found the sling procedure to be more effective than the Burch method for curing the problem of incontinence (although it involved more post operation complications) after weighing the two on the basis of a number of criteria’s like no urinary incontinence, no self-reported symptoms and no re-treatment for the condition.

"The sling was more effective in resolving urinary incontinence symptoms than the Burch, and it also showed significantly higher satisfaction rates," said Albo. "The trade-off was that there were higher rates of complications with the sling”, he added.

The results of the study brought forward the following picture as presented on Monday at the American Urological Association's annual meeting in Anaheim, California, after two years of follow up:

520 women (79%) completed the whole trial and found the sling method to be more effective than Burch.

326 incontinence facing women treated with the sling method showed a success rate of 66% as compared to 49% of the 329 treated with Burch with satisfactory levels of 86% and 78% respectively and the overall success rate remained equal to 47% versus 38%.

Adverse side effects, mainly urinary tract infections (others including persistent urge incontinence and voiding problems) were noticed to the extent of 63% in sling operations as compared to a lesser 47% in Burch method.

Dr Kris Strohbehn, of the Department of Obstetrics and Gynecology, Dartmouth Medical School, and the Division of Urogynecology and Reconstructive Pelvic Surgery, at Dartmouth-Hitchcock Medical Center, both in Lebanon New Hampshire, corroborated his findings in an editorial saying that the success rates of both methods have decline as compared to past studies, thought to be mainly due to the strict criteria for evaluation.

He also said that till date there is no such surgery that can give 100% success rate for this problem. “There are as many "shades of dry" as there are shades of gray.” he added.

Apart from the above two methods, he also mentioned a new easier surgery involving small incisions of synthetic “mesh” slings to bring the urethra back into position, causing less pain, faster recovery, lower cost and fewer complications, to be present at the option of the patients. In this method the patient can go back home on the day of the surgery unlike the sling and Burch surgery in which the patients needed to stay in the hospital overnight.

Based on the study and the evidence collected by the various number of operations conducted each year in US, the doctors intend to counsel their patients on the pros and cons of each surgery.

According to a survey around 40% of college women are described to have symptoms of urinary dysfunction.

Incontinence among women is mainly of three types, urge, stress and overflow.

Urge incontinence occurs due to uninhibited bladder contraction and involves a sudden urge to urinate followed by urine leakage.

Stress incontinence occurs due to increased intra abdominal pressure and results in small to moderate amounts of urine loss occurring with sneezing, coughing, laughing, possibly standing.

Overflow incontinence occurs due to neurogenic factors and causes small leakage of urine and no urge to urinate.