Late-Breaking: Ten-Year Outcomes: Burch vs. Midurethral Sling in Sacrocolpopexy RCT

Objectives: This study aims to compare the 10-year urinary continence rates between Burch retropubic urethropexy and retropubic midurethral sling procedures in women with urinary incontinence undergoing abdominal sacrocolpopexy.

Methods: We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial that enrolled participants from June 2009 to August 2013 to compare the outcomes of Burch urethropexy and retropubic midurethral sling (Figure 1). The primary objective outcomes were assessed in patients who completed the 10-year follow-up through review of the electronic medical records and response to mailed validated questionnaires. Two primary outcomes were assessed: 1. Reoperation for recurrent SUI and 2. Composite continence requiring no reoperation for recurrent SUI and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) response of ≤ 5. Composite primary outcome was assessed with intention-to-treat (ITT) and within-protocol analyses (WPA). Comparisons between groups were evaluated using χ2 or Fisher exact test.

Results: The two groups were similar in all measured baseline characteristics (Table 1). At a mean follow-up of 10.1 years (median 12 years), there was no significant difference in the proportion of women who required a reoperation for recurrent SUI between the groups (89.5% [51/57] Burch vs. 98.2% [55/56] sling; p = 0.113). Similarly, there was no statistically significant difference in the composite continence between the groups (13.4% [7/53] Burch vs. 20.4% [11/54] sling; p = 0.322 for ITT; 24.1% [7/29] Burch vs. 40.7% [11/27] sling; p = 0.184 for WPA).

Conclusions: There was no significant difference in reoperation rates or urinary continence rates at the 10-year follow-up between women who received a retropubic midurethral sling and those who underwent Burch retropubic urethropexy. These findings suggest that both surgical approaches offer comparable long-term outcomes for patients in terms of surgical success and continence.