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Burch Urethropexy Technique Appears More Successful Than Marshall-Marchetti-Krantz in Improving Stress Incontinence: Presented at AUGS

By Paula Moyer

SAN DIEGO, CA -- August 2, 2004 -- The Burch technique of urethropexy is more likely to correct or improve stress incontinence than is the Marshall-Marchetti-Krantz (MMK), say researchers.

In a presentation here July 29^th at the 2004 American Urogynecologic Society/Society of Gynecologic Surgeons Joint Scientific Meeting, principal investigator Rebecca J. McCrery, MD, said, "We found that over 93% of patients who underwent Burch procedures were cured of incontinence or improved, compared to just over 75% of MMK procedures." She added, "Women who had preoperative urodynamic studies and underwent MMK were more likely to have an unsuccessful outcome, while the urodynamic studies had no bearing on success in the Burch group." Dr. McCrery is a fellow in female pelvic medicine and reconstructive surgery at Baylor College of Medicine in Houston, Texas.

She and her coinvestigators wanted to know whether the Burch or MMK urethropexy was more effective in correcting stress urinary incontinence and if preoperative urodynamic studies had an effect on the success of either urethropexy method. In both cases, the procedures were performed concurrently with paravaginal defect repair.

The researchers conducted a prospective, randomized study on 138 women who underwent surgery for anterior vaginal wall prolapse and stress incontinence. All the surgeries were performed by the same surgeon between 1998 and 2003. The investigators excluded patients who had had a prior retropubic urethropexy or a cough leak point pressure of less than 60 cmH₂O. Either the referring physician or the surgeon conducted preoperative urodynamic studies when they suspected intrinsic sphincter deficiency or urge incontinence.

All patients underwent a paravaginal defect repair and were then randomized to undergo either a Burch or MMK urethropexy. The surgeon used permanent sutures at all sites. The patients were followed afterward with either a mail-in or telephone-interview questionnaire. The investigators used the responses to categorize the surgeries as having cured, improved, or failed.

Seventy-two patients underwent the MMK urethropexy and 66 underwent the Burch procedure. The groups were similar in terms of their age, race, smoking status, and weight. They were also similar in their preoperative need for pad use. Among the MMK patients, 59.7% underwent preoperative urodynamic studies, compared to 65.7% of Burch patients. In each group, 87.7% were available for follow-up, which was an average of 28.8 months for the MMK group and 24.2 months for the Burch group.

After the investigators adjusted for the difference in months of follow-up, they found a higher surgical failure rate in the MMK group, 24.6%, compared to 8.3% of the Burch group (P = .0238). In the MMK group, 35% of women who had preoperative urodynamic studies had failed surgeries, compared with 4.8% of those who did not undergo these studies. In the Burch group, the studies were not associated with differences in outcomes.

"We don't know why the MMK group failure rate was even higher in the women having urodynamic studies," Dr. McCrery said. Further studies would be needed to see if this finding is reproducible, she said.


[Presentation title: Outcomes of Urethropexy Added to Paravaginal Defect Repair: A Randomized Trial of Burch versus Marshall-Marchetti-Krantz. Abstract 6]

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