Stress urinary incontinence has a prevalence of up to 50%. The open Burch colposuspension was first described in 1961. This procedure proved to be very effective in the treatment of genuine stress urinary incontinence and it remained the gold standard until the advent of the midurethral sling in 1995. Although the laparoscopic Burch was also introduced in the early 1990’s the midurethral sling gained rapid traction due to the minimally invasive nature, ease of use, decreased operating time and excellent short and long term results. With the passage of time several studies have highlighted the potential complications associated with the use of vaginal mesh. The public’s perception on the use of vaginal mesh has shifted the attention back to non mesh options in the treatment of genuine stress incontinence. The aim of this article is to clarify the role of the Burch colposuspension in the era of the midurethral sling. The review will highlight the efficacy of the open versus the Laparoscopic Burch, discuss potential complications associated with this technique and also compare the laparoscopic Burch directly with the transvaginal and transobturator midurethral slings. The selection of patients and surgical technique for the laparoscopic Burch are also discussed.
The Burch procedure remains an excellent choice for the treatment of genuine stress urinary incontinence in patients that wish to avoid the use of vaginal mesh.