Since 1949, when Marshall et al. first described retropubic urethrovesical suspension for the treatment of stress urinary incontinence, and since Burch's landmark article in 1961, retropubic procedures have emerged as consistently curative.Although numerous terminologies and variations of retropubic repairs have been described, the basic goal remains the same: to suspend and stabilize the anterior vaginal wall, and thus the bladder neck and proximal urethra, in a retropubic position. This prevents their descent and allows for urethral compression against a stable suburethral layer. We select a retropubic approach (versus a vaginal approach) depending on many factors, including the need for laparotomy for other pelvic disease, the amount of pelvic organ relaxation, and whether a vaginal or abdominal procedure will be used to suspend the vagina. Additionally, the age and health status of the patient, and the preferences of the patient and surgeon are also determining factors. We generally do not perform a retropubic procedure for intrinsic sphincter deficiency.
Few data differentiate one retropubic procedure from another, although all have advantages and disadvantages. The three most studied and popular retropubic procedures are the Burch colposuspension, the Marshall-Marchetti-Krantz (MMK) procedure, and the paravaginal defect repair. At the Cleveland Clinic, we prefer the Burch colpo-suspension for urodynamic stress incontinence with bladder neck hypermobility and adequate resting urethral sphincter function, and we combine it with a paravaginal defect repair when the patient has stage II anterior vaginal prolapse or when a concurrent sacral colpopexy is to be done. We do both open and laparoscopic retropubic repairs; laparoscopic techniques will be discussed elsewhere. We no longer perform MMK procedures, so this operation will not be described. The surgical techniques described herein are contemporary modifications of the original operations: Tanagho in 1976 described the modified Burch colposuspension; the paravaginal defect repair has been described by Richardson et al. and Shull and Baden. Although less critically studied, the paravagi-nal defect repair is regionally popular and widely performed in the United States.
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References
Marshall VF, Marchetti AA, Krantz KE. The correction of stress incontinence by simple vesicourethral suspension. Surg Gynecol Obstet 1949;88:509.
Burch JC. Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol 1961;81:281–290.
Tanagho EA. Colpocystourethropexy: the way we do it. J Urol 1976; 116:751–753.
Richardson AC, Edmonds PB, Williams NL. Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 1981;57:357–362.
Shull BL, Baden WF. A six-year experience with paravaginal defect repair for stress urinary incontinence. Am J Obstet Gynecol 1989; 160:1432–1439.
Colombo M, Milani R,Vitobello D, Maggioni A. A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence. Am J Obstet Gynecol 1996;175:78–84.
Walters MD, Karram MM. Urogynecology and Reconstructive Pelvic Surgery. 2nd ed. St. Louis: Mosby; 1999.
Alcalay M, Monga A, Stanton SL. Burch colposuspension: a 10–20 year follow up. Br J Obstet Gynaecol 1995;102:740–745.
Black NA, Downs SH. The effectiveness of surgery for stress incontinence in women: a systematic review. Br J Urol 1996;78: 497–510.
Ward K, Hilton P. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ 2002;325:1–7.
Steel SA, Cox C, Stanton SL. Long-term follow-up of detrusor instability following the colposuspension operation. Br J Urol 1986;58: 138–142.
Kobak WH, Walters MD, Piedmonte MR. Determinants of voiding after three types of incontinence surgery. Obstet Gynecol 2001; 97:86–91.
Langer R, Ron-El R, Neuman M, Herman A, Bukovsky I, Caspi E. The value of simultaneous hysterectomy during Burch colposuspension for urinary stress incontinence. Obstet Gynecol 1988;72:866–869.
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Walters, M.D. (2008). Retropubic Therapy for Stress Incontinence. In: Davila, G.W., Ghoniem, G.M., Wexner, S.D. (eds) Pelvic Floor Dysfunction. Springer, London. https://doi.org/10.1007/978-1-84800-348-4_20
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