Nazlı  Şener

Bandırma Onyedi Eylül University, Faculty of Medicine, Department of Gynecology and Obstetrics, Balıkesir, Türkiye

Şener N. Colposuspension. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.197-204.

ABSTRACT

Stress urinary incontinence (SUI) is a common condition characterised by involuntary urinary incontinence in situations that suddenly increase intra-abdominal pressure such as coughing, laughing, sneezing, heavy lifting. This clinical picture is an important health problem that negatively affects the quality of life, especially in women, and surgical treatment options are determined according to the anatomical condition and lifestyle of the patient. In the historical development process, surgical approaches, which first emerged in the early 20th century and evolved with various techniques, nowadays show diversity with the contribution of modern technologies.

In terms of surgical techniques, the basic methods of retropubic colposuspension include Burch and Marshall-Marchetti-Krantz (MMK) techniques. The Burch method places the bladder neck in a cranio-ventral position by fixing the sutures placed in the endopelvic fascia on the anterior wall of the vagina to the periosteum of the pubic bone. This technique has achieved high success rates in the long term and is especially preferred in patients in whom the use of mesh is unfavourable or contraindicated. MMK is applied by tying the paraurethral sutures at the level of the bladder neck to a Teflon knot instead of the pubic periosteum and is especially preferred in stress incontinence due to mobile bladder neck. The success rates of both methods vary between 60-90% in long-term follow-up, and the longterm success rates of the Burch procedure are particularly high.

Paravaginal colposuspension is a method that aims to repair defects in the pelvic fascia and reconstruct the anatomy of the bladder and urethra without using mesh. Long-term results show 65-90% success rates and it is especially preferred in cases accompanied by urethral hypermobility and prolapse. The advantages of this method include providing physiological and long-lasting support suitable for the anatomical structure. In addition, the fact that it can be applied in open, laparoscopic and robotic platforms facilitates its use in large patient groups.

Today, technological developments play an important role in surgical techniques. Laparoscopic and robotic approaches are less invasive than open surgery, shorten hospital stay, and reduce postoperative pain and complication rates. Laparoscopic retropubic colposuspension is preferred for aesthetic advantages and acceleration of the healing process, while robotic techniques facilitate suture placement and reduce complication rates thanks to three-dimensional imaging and ergonomic advantages. However, high cost and steep learning curve are factors limiting the widespread use of these technologies.

In terms of complications, bleeding and organ injuries in the intraoperative period, infection and retention in the early period, recurrence, prolapse and de novo urge incontinence can be seen in the long term. In long-term follow-up, it has been reported that techniques without the use of mesh, especially Burch and paravaginal methods, have high success rates and low complication rates. In addition, longterm results show that success rates decrease over time and failures are more common in the first two years.

Current guidelines and clinical approaches suggest that mesh-free techniques should be preferred in cases where mesh use is unfavourable or contraindicated. Especially in patients with pure stress incontinence and mobile bladder neck, open, laparoscopic or robotic Burch colposuspension is accepted as the first choice. While these techniques give similar results in terms of success rates, the choice should be based on the patient’s condition and the surgeon’s experience. In addition, technological developments and new surgical approaches increase treatment success and decrease complications.

In conclusion, surgical treatment options for stress urinary incontinence have been diversified and optimised with the contribution of historical development and modern technologies. Today, Burch and paravaginal techniques stand out as reliable options that provide long-term and physiological support, especially in cases where mesh use is inconvenient or the risk of failure is high. The choice of surgical approach should be based on the patient’s anatomical condition, lifestyle and the surgeon’s experience and should aim to maximise patient satisfaction.

Keywords: Urinary incontinence; Stress; Laparoscopy; Postoperative complications; Recurrence