Surgical treatment of stress urinary incontinence: comparison of robotic-assisted Burch urethropexy with retropubic midurethral sling. 2023

Alexandra I Melnyk, and Nicole Meckes, and Amanda Artsen, and Stephanie Glass Clark, and Philip J Grosse, and Michael Bonidie
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, PA, USA. aimelnyk3@gmail.com.

Synthetic retropubic midurethral slings (RMUS) and robotic-assisted Burch urethropexies (RA-Burch) are common surgical treatment options for stress urinary incontinence (SUI). Few data exist comparing the success of these two retropubic surgeries. This retrospective cohort study of RA-Burch and RMUS procedures compared the proportion of patients with subjective cure after RA-Burch compared to RMUS at our institution between 2016 and 2020. Subjective cure was defined as reporting no symptoms of SUI at longest follow-up. Chi-square, Fisher's exact, Mann-Whitney U tests, logistic regression, and Kaplan-Meier log-rank tests were used in analyses. The overall cohort of 235 subjects included 47 RA-Burch cases matched 1:4 with 188 RMUS cases. Patients who underwent RA-Burch were younger (p < .01), had lower BMIs (p = .04), and were more likely to have concomitant procedures, including hysterectomy (p < .01). There was no difference in subjective cure at longest follow-up (p = .76). Median follow-up was longer in the RA-Burch group (p < .01). There was no difference in early postoperative complications, EBL, treatment for persistent SUI, or new urge urinary incontinence at longest follow-up. Both groups experienced postoperative urinary retention at a similar rate, although 4 RMUS patients required sling lysis and one patient experienced a mesh exposure. Patients undergoing RA-Burch had significantly longer OR times when no concomitant procedure was performed (p < .01). There were no significant predictors of SUI recurrence when controlling for baseline variables. This study suggests that RA-Burch and RMUS may be equally efficacious for patients with symptoms of SUI desiring surgical management.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013520 Urologic Surgical Procedures Surgery performed on the urinary tract or its parts in the male or female. For surgery of the male genitalia, UROLOGIC SURGICAL PROCEDURES, MALE is available. Procedure, Urologic Surgical,Procedures, Urologic Surgical,Surgical Procedure, Urologic,Surgical Procedures, Urologic,Urologic Surgical Procedure,Urological Surgical Procedures,Procedure, Urological Surgical,Procedures, Urological Surgical,Surgical Procedure, Urological,Surgical Procedures, Urological,Urological Surgical Procedure
D014550 Urinary Incontinence, Stress Involuntary discharge of URINE as a result of physical activities that increase abdominal pressure on the URINARY BLADDER without detrusor contraction or overdistended bladder. The subtypes are classified by the degree of leakage, descent and opening of the bladder neck and URETHRA without bladder contraction, and sphincter deficiency. Urinary Stress Incontinence,Incontinence, Urinary Stress,Stress Incontinence, Urinary
D053825 Suburethral Slings Support structures, made from natural or synthetic materials, that are implanted below the URETHRA to treat URINARY STRESS INCONTINENCE. Male Slings,Male Urethral Slings,Mid-Urethral Slings,Midurethral Slings,Tension-Free Vaginal Tape,Tensionless Vaginal Tape,Trans-Obturator Tape,Transobturator Suburethral Tape,Transobturator Tape,Urethral Slings,Male Sling,Male Urethral Sling,Mid Urethral Slings,Mid-Urethral Sling,Midurethral Sling,Sling, Male,Sling, Male Urethral,Sling, Mid-Urethral,Sling, Midurethral,Sling, Suburethral,Sling, Urethral,Slings, Male,Slings, Male Urethral,Slings, Mid-Urethral,Slings, Midurethral,Slings, Suburethral,Slings, Urethral,Suburethral Sling,Suburethral Tape, Transobturator,Suburethral Tapes, Transobturator,Tape, Tension-Free Vaginal,Tape, Tensionless Vaginal,Tape, Trans-Obturator,Tape, Transobturator,Tape, Transobturator Suburethral,Tapes, Tension-Free Vaginal,Tapes, Tensionless Vaginal,Tapes, Trans-Obturator,Tapes, Transobturator,Tapes, Transobturator Suburethral,Tension Free Vaginal Tape,Tension-Free Vaginal Tapes,Tensionless Vaginal Tapes,Trans Obturator Tape,Trans-Obturator Tapes,Transobturator Suburethral Tapes,Transobturator Tapes,Urethral Sling,Urethral Sling, Male,Urethral Slings, Male,Vaginal Tape, Tension-Free,Vaginal Tape, Tensionless,Vaginal Tapes, Tension-Free,Vaginal Tapes, Tensionless
D065287 Robotic Surgical Procedures Surgical procedures performed remotely using a computer that controls surgical instruments attached to mechanical arms designed to perform the tasks of the surgeon. Robot Surgery,Robot-Assisted Surgery,Robot-Enhanced Procedures,Robot-Enhanced Surgery,Robotic-Assisted Surgery,Surgical Procedures, Robotic,Procedure, Robot-Enhanced,Procedure, Robotic Surgical,Procedures, Robotic Surgical,Robot Assisted Surgery,Robot Enhanced Procedures,Robot Enhanced Surgery,Robot Surgeries,Robot-Assisted Surgeries,Robot-Enhanced Procedure,Robot-Enhanced Surgeries,Robotic Assisted Surgery,Robotic Surgical Procedure,Robotic-Assisted Surgeries,Surgery, Robot,Surgery, Robot-Assisted,Surgery, Robot-Enhanced,Surgery, Robotic-Assisted,Surgical Procedure, Robotic

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