A Retrospective Review of Perioperative Complications in 360 Patients who had Burch Colposuspension
Authors: Demirci Fuat , Yucel Nese , Ozden Selcuk , Delikara Nuri , Yalti Serap , Demirci Elif 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it reports a large experience with the Burch colposuspension operation and presents the complications encountered. It also provides a detailed review of the complications reported by others. In this series of 360 patients, 75.8% had an abdominal hysterectomy performed at the time of the Burch colposuspension. Our urogynaecologist reviewer tells us that this is a very high proportion of hysterectomies although there is a body of opinion that believes that a hysterectomy improves the results when the Burch operation is done in the treatment of women with genuine stress incontinence of urine. The incidence of hysterectomy has to be factored in to the data presented in this paper with regard to the complications that followed the operation. N.B.

AUTHORS RESPONSE TO EDITORIAL COMMENT

Most of our patients had hysterectomy together with the Burch procedure but not because we believe that a hysterectomy improves the results when a Burch colposuspension is performed. The prevalence of genuine stress incontinence is high in Turkey, being associated with a high birth rate and poor obstetric care. Turkish women who suffer from genuine stress incontinence view incontinence as a normal consequence of bearing children and/or growing older. Only a few seek therapy for incontinence. Most attend hospital for other gynaecological pathology and clinicians become aware of their urinary incontinence while taking the history and add anti‐incontinence surgery to any other necessary procedure, which is commonly hysterectomy. A recent study of incontinence in Turkish menopausal women showed the prevalence of urinary incontinence to be 37% but only 7% sought treatment. Of women with urinary incontinence 62% viewed the incontinence as a normal consequence of bearing children or growing older, 8% did not know that is was treatable, and 23% were too embarrassed to speak to their physician about it.

Summary: This retrospective study reviews intraoperative and early complications of Burch colposuspension of 360 patients. Ten patients had massive haemorrhage and 8 of them had a blood transfusion. Three patients had a haematoma. Bladder injuries were noticed in 10 patients, 3 of whom were diagnosed postoperatively. One patient had unilateral ureteral kinking. Urinary retention occurred in 20 patients for more than 10 days and 2 required catheterization for 26 and 32 days respectively. Eighteen patients had a wound infection and 4 had a wound abscess. Twenty nine patients had a urinary infection. Urinary tract injury, haemorrhage and blood transfusion were significantly more common in women having secondary surgery than those having primary surgery. Deep venous thrombosis was diagnosed in 3 patients who had a Burch colposuspension with concomitant abdominal hysterectomy. Knowledge of possible risks and complications of Burch colposuspension may help plan a better preoperative work‐up of patients and may minimize the intraoperative complications and increase surgical success and patient satisfaction.