Long Term Follow-up of Burch versus Sling with Concomitant Sacrocolpopexy

Objectives: The long-term outcomes of patients undergoing Burch urethropexy or midurethral sling concomitantly with sacrocolpopexy remain unknown. This study aimed to assess the long-term stress incontinence recurrence and complication rates among those undergoing anti-incontinence procedures with simultaneous sacrocolpopexy.

Methods: A single-centered retrospective cohort study of female patients who underwent anti-incontinence surgery with concomitant prolapse surgery between January 2009 and December 2013 was conducted. Recurrent stress urinary incontinence (SUI) was defined as the complaint of urinary leakage related to physical activities at any time since the index surgery or reoperation. This information was abstracted from all subsequent visits to the urogynecology, gynecology, urology and women's’ health visit up until March 31, 2024. Additionally, we are assessing present urinary incontinence symptoms with validated questionnaires (ICIQ and UDI-6). We also evaluated incontinence surgery and mesh related complications as secondary outcomes. Comparison were evaluated descriptive statistics; t-test for continuous variables and χ2 test or Fisher exact test for categorical variables as appropriate.

Results: A total of 233 women were identified meeting study criteria; 99 (42.5%) who underwent an abdominal sacrocolpopexy and midurethral sling, 83 (37.8%) who has a abdominal sacrocolpopexy and Burch urethropexy, and 46 (19.7%) who had a robotic sacrocolpopexy and midurethral sling during this period. Mean follow-up was 9.5 (0.5) years. Baseline demographics are presented in table 1. There was no significant difference in the rate of interval treatment for recurrent SUI among the three study groups (p>0.05) (Table 2). However, patients who underwent robotic sacrocolpopexy with midurethral sling exhibited higher rate of interval complications compared to the other groups (n=8/99 (8.1%) versus n=7/83 (8.0%) versus n=11/46 (23.9%); p=0.0091). Compared to open sacrocolpopexy with sling or Burch, patients who had a robotic procedure had higher rate of urinary obstruction/incomplete bladder emptying (n=2/99 (2.0%) versus n=2/87 (2.3%) versus n=5/46 (10.9%); p=0.0410) and recurrent urinary infection (n=0/99 (0%) versus n=0/87 (0%) versus n=3/46 (10.9%)p = 0.0080)(Table 2).

Conclusions: There was no difference in the interval treatment for recurrent SUI between the 3 groups. However, patients who had a robotic sacrocolpopexy and mid urethral sling demonstrated a higher rate of interval complications, including urinary obstruction/incomplete bladder emptying and recurrent urinary infection.