Five-year follow-up of laparoscopic bladder neck suspension using synthetic mesh and surgical staples.

We report long-term follow-up of 40 patients who underwent a laparoscopic adaptation of the Burch procedure between May 1990 and December 1992. This procedure, in which synthetic mesh and surgical staples are used in place of sutures to effect the suspension, was previously described by the principal author and colleagues for use in the treatment of genuine stress urinary incontinence (J Laparoendosc Surg 1993;3:563-566). Minimum 5-year follow-up has been obtained for 34 of these patients either by office visit with the principal author (27 patients) or by telephone interview with the patient or the patient's primary-care physician (7 patients). Six patients were lost to follow-up, four after 1 year and two more after 3 years. None of these patients was leaking at last follow-up. This operation initially succeeded in resolving incontinence in 37 of 40 patients (93%). Of the three patients in whom the surgery failed initially, none chose further surgery, and all three were still leaking after 5 years of follow-up. One additional patient developed urgency incontinence 3 years postoperatively. The five-year success rate, defined as no recurrent leaking, was 88% (30 of 34 confirmed outcomes). This modification of the Burch procedure offers the advantages of the laparoscopic approach and affords an inherently shorter learning curve than that associated with laparoscopic suturing in the confined pelvic space.