Last updated: 02/17/2009

There are a variety of retropubic suspension surgeries available to treat stress incontinence. The variations differ by the types of structures used to support the urethra and bladder. In all procedures, parts of the pelvic anatomy (pubic bone, ligaments)...

serve as an anchor or wall upon which the urethra is tacked for stability. The surgery is called a suspension surgery because it stabilizes the urethra from tilting by suspending it against a part of the pelvic anatomy. The Burch procedure is often performed when other surgery is needed such as repair of the urethra for cystoceles and urethral reconstruction. However, this procedure is the most difficult of the anti-incontinent surgeries and is more common in mild forms of stress incontinence where intrinsic sphincter deficiency is not present.

The Burch procedure can be done through open abdominal surgery, which requires a long incision at the bikini line, or surgery performed through the vagina. The patient, in stirrups, receives general anesthesia. Within the retropubic area, the anterior vaginal wall is separated from the bladder manually. The bladder neck is identified and old adhesions or fatty tissues are removed. The neck of the bladder is sutured to pubic ligaments where it will form adhesions and thereby gain stability. The surgeon examines for bladder injury and the surgery is completed. Urethral position is tested by placing a cotton-tipped swab in the urethra and measuring the angle. With abdominal surgery or vaginal surgery a catheter may be put in place by the surgeon for postoperative voiding and to decrease the risks of infection. A suction drain may be placed in the retropubic space for bleeding. The drain is removed one to three days after surgery.

Recently, laparoscopic surgery has been used to perform retropubic suspensions. Laparoscopic surgery requires only three or four 0.25-in (0.6-cm) incisions in the belly button, pubic hairline, or groin area and uses small instruments without opening the abdominal cavity. Shorter healing time is involved with this procedure, the hospital stay is usually not more than 24 hours and recovery to normal activities takes about seven to 14 days. However, the Burch procedure performed using laparoscopic techniques requires great skill on the part of the surgeon and research indicates that the results may not be as long lasting as those developed with abdominal or vaginal surgery.