Burch Colposuspension for Stress Incontinence (Laparoscopic)

Burch Colposuspension is a used to treat urinary incontinence in women.

First case series in Chennai




leakage of urine

At times, the muscles of the pelvic floor area can become lax and weak due to carrying and delivering babies, old age or other medical conditions. One such muscle, called the sphincter, controls the passage of urine. When it becomes weak, there may be unwanted leakage of urine.

Alternatively, instead of loosened sphincter muscle, an overactive bladder can also cause uncontrolled leakage of urine. This condition is called urinary incontinence.

Burch Colposuspension Background

The area between the urinary bladder and urethra is the bladder neck. Main aim is to stop leakage of urine by creating a small bend in the bladder neck. This is achieved by a procedure known as Burch Colposuspension. This has been regarded as the Gold Standard in treating Urinary incontinence in women. It has a high success rate of about 85%.

With new advances in technology, this can also be achieved by just placing a tension free vaginal tape in the middle portion of the urethra. Placing this tape creates a small kink in the urethra. This prevents easy leak of urine during stressful activities like coughing, sneezing, laughing, etc.

How Burch Colposuspension is Performed

  • Connector.Connector.

    Tiny key hole sized incisions are made in the patient’s abdomen. Special laparoscopic surgical instruments are inserted.

  • Connector.Connector.

    The neck of the bladder is identified and two sutures are taken on either sides. The other end of the surgical suture is pulled back and upwards and fixed to the tissues of the back.

  • Connector.Connector.

    This creates a bend and makes the bladder opening smaller. This reduces the leaking tendency.

  • Connector.Connector.

    The front wall of the vagina is carefully lifted and fixed onto a structure behind the hip bone, making the bladder opening smaller.

  • Connector.Connector.

    This helps control the pressure within the bladder when it is full preventing any unwanted leakage of urine. The instruments are then removed and incision is closed in layers, leaving no scars behind.

Principle of Burch Colposuspension

treatment window

While urinary incontinence is not life threatening, women with this condition suffer from frequent urinary track infection. Moreover, their social life can also become seriously restricted. So it is advisable to share ones problem with the surgeon and get it corrected with this simple procedure at the earliest.

life after laparoscopic burch colposuspension

One can go ahead with normal activities 2-3 days after surgery. However it is advised to avoid heavy weight lifting and strenuous physical activities for at least 10 days.
Vaginal strengthening exercises are also recommended.

Burch colposuspension FAQ’s

Your condition is known as stress urinary incontinence (SUI). There are a number of reasons for SUI, but one of the most common ones is the change in angle between urinary bladder and the urinary tube (urethra). So that any increase in pressure in the bladder brought about by cough, sneeze, etc., tends to send a wave of stress straight down into urethra, the resultant spilling of urine.
There are many causes, but one is recurrent pelvic surgery which alters the anatomical arrangement of the organs inside the pelvis. Meaning if the patient in question had a previous surgery around the pelvic area and something went wrong, there is a high likely hood that said patient might eventually suffer from urinary incontinence.

Nerve muscle co-ordination issues could also cause stress urinary incontinence.

At LIMA we would test for urinary infection, distal urethral stenosis, to confirm that you indeed require to be operated on. After this we move to the next stage of testing which consist of ultrasound, urinary analysis, urine culture and cystoscopy. If these all come back negative we weill know that the problem is in the pelvis. Hence to confirm the condition a pelvic floor assessment and a neruromuscular evaluation would be done to test the muscles, and if they are in fact weak, we will know for sure that the patient requires to be operated on.
Yes, all the correctable conditions like urinary infection , urethral stenosis , overflow incontinence , etc., should first be corrected. If after all of that you still present symptoms, then LIMA has two more options for you;

TVTO and Burch Colposuspension.

The TVTO is a specially designed sling that is put in between junction of the urinary bladder and the urethra to increase and sharpen the angle at which the organs rest. This sharpened angle prevents the urine from coming out straight when you cough sneeze or strain.
Burch Colposuspension has been frequently performed at LIMA. In this operation the angle between the urinary bladder and urethra are tightened or sharpened by taking a stream of sutures between the pelvic bone, which is in front of the bladder, and stitch it to the side of the vagina that is made out of the para-vaginal tissue. This sharpens the angle and prevents the stress urinary incontinence.

LIMA has had extremely good results using this surgical technique. Fortunately as this is a keyhole surgical technique, patient compliance is extremely high.

Burch Colposuspension Specialists

Dr. J. S. Rajkumar


M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)

Dr. Deepa Ganesh