The Burch procedure and paravaginal repair may be done through a large abdominal incision (laparotomy) but are better performed at laparoscopy – this allows for much faster recovery.  The laparoscopic Burch procedure is used to treat urinary stress incontinence (USI). The paravaginal repair is frequently performed at the time of laparoscopic Burch or may be performed by itself to correct a paravaginal defect, a type of pelvic prolapse, in which the vaginal walls cave in from the sides.  The procedures are performed under general anesthesia using a laparoscope through a small incision, usually in the bellybutton. Several (usually three) small incisions are made in the lower abdomen for insertion of other instruments needed to perform the procedure. An incision is made inside the abdominal cavity between the bladder and the back of the pubic bone (space of Retzius) in order to suspend the bladder and/or to perform a paravaginal repair. The technique most often used to perform the laparoscopic Burch involves placing permanent stitches adjacent to the neck of the bladder on each side and suturing them to a strong ligament (Cooper’s ligament) attached to the pubic bone. The paravaginal repair is very similar except that the stitches are placed in the side walls of the vagina and attached to strong tissue which is immediately adjacent to the vaginal walls. The incisions are closed and the procedure completed. Other surgical procedures, if appropriate, may be performed at the same time as the bladder suspension.

The likelihood of success of the laparoscopic Burch and the paravaginal repair procedures is reported to be 80-90% in most cases. "Success" means significant improvement or total elimination of the incontinence and/or correction of the paravaginal defects. The most common bladder tack performed by many gynecologists across the country is called an anterior repair or anterior colporrhaphy. Unfortunately, the long-term success rate in treating incontinence with this procedure alone is around 33%. The anterior repair may be performed at the same time as the Burch and/or paravaginal repair if there is a very large cystocele.

Alternatives to the laparoscopic Burch and/or paravaginal repair procedures include the following:

• do nothing and continue to experience the loss of urine
• medical (non-surgical) treatment
• lifestyle modification: quit smoking, lose weight, allergy treatment
• Kegel’s exercise: regular contraction of the muscles that allow you to stop urine in mid-stream may reduce or eliminate incontinence
• pessary use: usually a donut-shaped rubber or plastic device inserted into the vagina to support the bladder
• hormonal (estrogen) replacement therapy
• treatment with medication helps certain types of incontinence
• other surgical procedures including
  • the so-called anterior repair (performed from a vaginal approach),
  • other procedures performed in the space between the bladder and pubic bone (may be done at laparoscopy or through a large incision at laparotomy),
  • sling procedures usually done with an incision in the vagina and a 1-2" incision at the pubic hairline,
  • collagen injection (injection of a natural glue-like substance into the bladder neck), and
  • InterStim® - a nerve stimulator is surgically placed to reduce bladder irritability

Many times using a combination of several forms of treatment results in the best treatment for incontinence and paravaginal defects (such as losing weight, stopping smoking, taking estrogen replacement, performing Kegel’s exercise, and having the Burch procedure). If you have any questions regarding the above or any aspect of the proposed surgery, be sure to discuss them with your physician.