UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

BLADDER SUSPENSION (BURCH COLPOSUSPENSION)

Salih Yılmaz1 Serkan Aydoğdu2

1Private Practice of Gynecology and Obstetrics, İstanbul, Türkiye
2Private Practice of Gynecology and Obstetrics, İstanbul, Türkiye

Yılmaz S, Aydoğdu S. Bladder Suspension (Burch Colposuspension). In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.225-232.

ABSTRACT

Burch colposuspension was described by John Christopher Burch to treat stress urinary incontinence and anterior wall prolapses as cystocele in 1961. Burch colposuspension aims to reposition the bladder neck and proximal urethra back to the intra-abdominal pressure area behind the pubic symphysis. This repositioning significantly improves pressure transmission to the urethra. This procedure has been in use for over 60 years and its long-term success and complication rates are well known. Meta-analyses have reported a success rate of 85–90% at 1-year follow-up, and 70% at 5-year follow-up. All complications related to this operation have been thoroughly described. The operation begins with an incision of the endopelvic fascia to access Cooper’s ligament and the vaginal fascia. Blunt dissection is performed to separate the fascia from the lateral pelvic walls, while the vagina is elevated with the index finger to aid exposure. Three sutures are placed on each side of the vaginal fascia and anchored to Cooper’s ligament, with tension adjusted digitally. Tanagho’s 1976 modification involved placing sutures more laterally with looser approximation to reduce complications. A Foley catheter is used intraoperatively to help mobilize the bladder and prevent injury. Various suture materials have been used, with no clear superiority between absorbable and non-absorbable options. Although mid-urethral slings have become the gold standard, recent analyses suggest that Burch colposuspension may yield lower postoperative incontinence rates in some cases. With the growing prevalence of minimally invasive techniques in gynecologic surgery, it has been demonstrated that Burch colposuspension can be successfully performed using laparoscopic and robotic approaches. These minimally invasive methods offer comparable success rates to laparotomy, while providing additional benefits such as reduced postoperative pain, shorter hospital stays, and earlier return to daily activities. Because of laparoscopic or robotic application of this technique includes technically demanding steps like suturing, adequate training in minimally invasive surgery and considerable experience are required.

Keywords: Burch colposuspension; Bladder suspension; Cystocele

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