Clinical Outcomes

Reported continence rates for laparoscopic Burch colposuspension vary from 69% to 100%.3 Only half of the studies presented objective outcomes. Most authors reported less blood loss, shorter hospitalization, and less-frequent postoperative voiding dysfunction and de novo detrusor instability when compared with the abdominal route.

A recent systematic review5 of laparoscopic colposuspension summarized the findings of five randomized6-10 and three "quasi-randomized" trials.11-13 Analysis of subjective perception of cure showed no difference between open and laparoscopic colposuspension. When one poor-quality trial9 was excluded from the analysis for objective cure, the relative risk of a positive stress test at follow-up was less in the open colposuspension group but not significantly so when compared with the laparoscopic group. Based on a single trial, two stitches are better than one.11 The authors concluded that the evidence is limited by short-term follow-up and small numbers; therefore, valid conclusions are difficult to make. A current randomized clinical trial at our institution comparing laparoscopic Burch colposuspension and the tension-free vaginal tape procedure demonstrates superior subjective and urody-namic cure in the tension-free vaginal tape group at a median of 24.5 months. However, the sample size of our study is relatively small with 36 patients in each group and 2-year follow-up of all subjects is not yet complete. Cost was similar for both procedures.

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