Burch Colposuspension

​It is a well established abdominal operation to treat female stress urinary incontinence. The aim of the surgery is to lift the bladder neck to the strong ligaments on the pelvic bones using sutures.

The surgery may be done concurrently with other procedures, like removing the womb (uterus), for benign conditions such as uterine fibroids or uterine prolapse.

Why Is It Performed?

It is performed to cure female stress urinary incontinence caused by a loose and hypermobile bladder neck. The success rate is 85% at 1 year; 80% at 5 years and 70% at 10 years after surgery.

What are the bladder specific complications in burch colposuspension?

They are:

• Recurrence or persistent urinary incontinence
• Need to go to the toilet frequently
• The sudden and sometimes uncontrollable urge to pass urine
• Unable to empty the bladder completely, which may lead to prolonged catheterisation or intermittent self-catheterisation while awaiting for the return of normal bladder function
• Prolapse of the womb and the rectum

What are the risks associated with burch colposuspension?

It is a relatively safe procedure. However, like all surgeries, complications may occasionally occur. These include:

• Risk of anaesthesia
• Bleeding
• Infection
• Injury to surrounding tissues (e.g. bladder, ureter and blood vessels)
• Formation of blood clot in the legs or lungs

Are there alternatives?

There are other surgeries that can be done to correct female stress urinary incontinence. Tension-free vaginal tape (TVT or TVT-O) insertion is an alternative that is now the most effective continence surgery.

Non-surgical alternatives include:

• Lifestyle modification, avoidance of precipitating factors like constipation
• Pelvic floor exercises, electrical stimulation +/- biofeedback
• Vaginal cones
• Vaginal pessary

Preparations prior to surgery

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health.
2. Your doctor may prescribe oral or vaginal oestrogen (hormone) if you are already menopausal. It important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.
3. You will generally be admitted one day before your surgery.
4. You will be given preparations to clear your bowels and have the pubic area shaved.
5. You will not be allowed to eat or drink after midnight on the day before surgery.
6. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.
7. If you are on aspirin, please inform your doctor. You must stop taking aspirin at least a week before surgery.

In The Operating Theatre

The surgery may be done under regional anaesthesia (which involves the injection of a local anaesthetic medicine into the spine while you are awake) or general anaesthesia (where you will be asleep throughout the operation). The anaesthetist will discuss will you the advantages and disadvantages of both methods.

The operation involves a "bikini" line cut just below the pubic hairline. The surgery takes about 45 minutes to complete.

At the end of surgery, a tube will be inserted into the bladder through the abdominal wall (suprapubic catheter) or the urethra (urethral catheter). Another tube (drain) will also be inserted to drain blood from the site of surgery.

​Post-operative advice

1. Immediately after the operation, you may experience:
   • Nausea and occasionally vomiting - You should rest; medication will be given to relieve these symptoms.
   • Pain from the wound - this can be relieved by painkillers.
   • Tiredness / weakness - You should rest and gradually increase your activity until you feel fit to return to your normal activities. A physiotherapist is available to help you.
2. One day after surgery, you should be able to drink and eat. You are encouraged to move around.
3. Bladder training process will start 2 days after surgery. The urinary tube will be clamped or removed, and you would be encouraged to pass urine as much as you can, and the volume of any remaining urine in your bladder will be measured. If you are able to empty your bladder adequately, the tube will be removed on the following day.
4. The drain will be removed one to 2 days after surgery when the drainage is minimal.
5. You are expected to stay in hospital for an average of 4 days.
6. You are advised not to engage in sexual activity, drive or douch your vagina for a month after surgery.
7. You are advised not to carry heavy weights (of more than 5 kg) in the long run and not to do abdomen exercise for the first 2 months after surgery.
8. You will be given one month of hospitalisation leave upon your discharge.
9. You should immediately return to the Urogynaecology Centre (during office hours) or the KK 24-hour Women's Clinic if you have the following symptoms:
   • Heavy vaginal bleeding
   • Severe abdominal distension and / or pain
   • Foul-smelling discharge from wound
   • High fever
   • Pain when passing urine
   • Difficulty in passing urine
   • Constipation
   • Pain or swelling in the calves

Follow-up visits

After the operation, you are required to return for regular follow-up care. You will be seen at 1 week, 1 month, 6 months, 1 year and yearly thereafter. Urodynamic studies will be repeated at 6 months after surgery to confirm cure and to exclude other bladder disorders.