After the diagnosis of urodynamic stress incontinence has been made and the patient has opted for surgical management, the choice of laparoscopic versus open retropubic colposuspension depends on several factors: previous pelvic or anti-incontinence surgery; history of severe abdominopelvic infection or known extensive abdominopelvic adhesions; patient ability to undergo general anesthesia; need for concomitant abdominal, pelvic, or vaginal surgery; patient preference, and operator experience and preference.3 Most laparoscopic colpo-suspensions have been done for primary stress incontinence because of difficulty in dissecting retropubic adhesions; however, dissection of the space of Retzius seems easier even when compared with open access once a surgeon has gained sufficient experience. I prefer the laparoscopic Burch colposuspension rather than mid urethral slings for the treatment of stress-provoked detrusor overactivity.

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