Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

AIM:To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence(SUI)and improve patient satisfaction.METHODS:Women who underwent a combined sling removal and laparoscopic Burch procedure between2009 and 2014 were matched via age and sling-type in a 1:2 ratio to women who only underwent a sling removal.Those who underwent surgery within 6 mo of data collection were excluded from the study,as were women who underwent multi-stage surgery.Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6(UDI-6)and incontinence impact questionnaire-7(IIQ-7)per the standard clinical practice.All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard followup questions.Research staff contacted participants via email,mail,and telephone using the same questionnaire template and script.Data was analyzed by using x^2 test for categorical data,and Student’s t test and Wilcoxon Rank Sum test for continuous data.The measure of effect was determined by logistic regression analysis.RESULTS:A total of 48 women out of 146 selected patients were successfully recruited with n=22 in the Burch cohort and n=26 in the control cohort.The mean age was 54.7±7.8 years and mean body mass index was 22.0±13.9 kg/m^2.The majority of patients were Caucasian(73.3%),postmenopausal(91.1%),nonsmokers(57.9%),with a history of hysterectomy(81.4%).Six nineteen point six percent of women presented after at least 2 years from placement,which was significantly more common in the Burch cohort.Pain was the most common chief complaint(64.4%)in both groups at the time of initial presentation,and 78.9%of women reported concomitant urinary incontinence.There was no significant difference in pre-operative UDI-6 and IIQ-7scores between the two cohorts.However,the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of28.41 points compared to a decrease of 4.01 points in the control group(P=0.02,95%CI:3.84 to 44.97).Although not statistically significant,the Burch cohort was 58%more likely to show an overall improvement in their score after surgery and 40%more likely to meet the minimal important difference of 11 points(RR=1.58,95%CI:0.97 to 2.57;RR 1.40,95%CI:0.79 to 2.46).The difference in IIQ scores was nonsignificant.There was no significant difference in blood loss,complications,or postoperative pain or dyspareunia.CONCLUSION:Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptomrelated quality of life scores.

AIM： To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would signifcantly decrease subjective symptoms of stress urinary incon-tinence （SUI） and improve patient satisfaction.METHODS： Women who underwent a combined sling removal and laparoscopic Burch procedure between 2009 and 2014 were matched via age and sling-type in a 1：2 ratio to women who only underwent a sling removal. Those who underwent surgery within 6 mo of data collection were excluded from the study, as were women who underwent multi-stage surgery. Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6 （UDI-6） and incontinence impact ques-tionnaire-7 （IIQ-7） per the standard clinical practice. All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard follow-up questions. Research staff contacted participants via email, mail, and telephone using the same questionnaire template and script. Data was analyzed by using c2 test for categorical data, and Student’s t test and Wilcoxon Rank Sum test for continuous data. The measure of effect was determined by logistic regression analysis.RESULTS： A total of 48 women out of 146 selected patients were successfully recruited with n = 22 in the Burch cohort and n = 26 in the control cohort. The mean age was 54.7 ± 7.8 years and mean body mass index was 22.0 ± 13.9 kg/m2. The majority of patients were Caucasian （73.3%）, postmenopausal （91.1%）, non-smokers （57.9%）, with a history of hysterectomy （81.4%）. Six nineteen point six percent of women presented after at least 2 years from placement, which was signifcantly more common in the Burch cohort. Pain was the most common chief complaint （64.4%） in both groups at the time of initial presentation, and 78.9% of women reported concomitant urinary incontinence. There was no signifcant difference in pre-operative UDI-6 and IIQ-7 scores between the two cohorts. However, the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of 28.41 points compared to a decrease of 4.01 points in the control group （P = 0.02, 95%CI： 3.84 to 44.97）.Although not statistically significant, the Burch cohort was 58% more likely to show an overall improvement in their score after surgery and 40% more likely to meet the minimal important difference of 11 points （RR = 1.58, 95%CI： 0.97 to 2.57; RR 1.40, 95%CI： 0.79 to 2.46）. The difference in IIQ scores was nonsignificant. There was no signifcant difference in blood loss, complications, or postoperative pain or dyspareunia.CONCLUSION： Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptom-related quality of life scores.