A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence

OBJECTIVE: Our aim was to compare Burch colposuspension and paravaginal repair for success rates, complications, and urodynamic effects when the procedures are used in the treatment of stress urinary incontinence. STUDY DESIGN: Thirty-six patients were enrolled. A full urodynamic evaluation was repeated 6 months postoperatively. RESULTS: Twelve (67%) and 17 (94%) subjects (Burch colposuspension vs paravaginal repair) voided spontaneously before discharge ( p = 0.04). One patient receiving the Burch procedure underwent urethral dilation for urinary retention. Follow-up was for 1 to 3 years. Differences in subjective and objective cure rates favored the Burch colposuspension over the paravaginal repair: 100% versus 72% ( p = 0.02) and 100% versus 61% ( p = 0.004), respectively. The paravaginal repair did not produce significant modifications in profilometry. Postoperatively, cotton swab tests had negative results in all patients with the Burch operation and in 33% of those with the paravaginal repair ( p = 0.01). CONCLUSION: Paravaginal repair is not recommended for the treatment of stress incontinence, although it was accompanied by a more immediate resumption of voiding. (Am J Obstet Gynecol 1996;175:78-84.)