Burch Sling

Outpatient Burch-Sling Procedure

A NERVE SPARING METHOD FOR CORRECTION OF FEMALE URINARY INCONTINENCE

Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity.


The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence without the use of mesh. The procedure involves retropubic urethropexy using the FDA-approved Trilift Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection.

Surgery of Burch Sling with Correction of Pelvic Organ Prolapse: Options

  1. Nerve Sparing Surgical Correction of Uterovaginal Prolapse Abdominal surgery
    • With hysterectomy
    • Without hysterectomy
  2. Nerve Sparing Surgical Corrections of Uterovaginal Prolapse Vaginal surgery
    • Colpocleisis (unable to do sexual intercourse)
    • Vaginal method (able to do sexual intercourse)
  3. Nerve Sparing Correction of Vaginal Vault Prolapse
    • Vaginal method
    • Abdominal method


Over five hundred cases at the Huntington Beach Hospital and the UCI Fountain Valley Hospital in the past 15 years were included in this study. There were no major complications. With this technique, we can treat anatomical urinary stress incontinence and pelvic organ prolapse. The surgical procedure can be done using the Trilift Burch Sling device through the vaginal approach, as well as the abdominal approach with or without hysterectomy.

BACKGROUND :
This is a report of a new technique and experience performing Outpatient Burch-Sling with No Laparotomy or Laparoscopy as a Nerve Sparing Technique. The purpose of this operation is to describe the surgical approach to genuine stress urinary incontinence, which hopefully will prevent injuries to somatic nerve fibers:

  • External urethral sphincter nerve
  • Dorsal nerve of clitoris
  • Posterior nerve of labia majora
  • Posterior nerve of labia minora, plus
  • Vaginal nerves from autononilc nerve division


TECHNIQUE :
The procedure is a retropubic bladder neck suspension using a newly invented bladder saver device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction. This repositions the proximal urethra within the abdominal cavity toward Cooper’s Ligament with permanent sutures. In this method the vaginal wall is used as an endogenous suburethral sling.

 

EXPERIENCE :
Fifty eight cases have been performed with no major complications and only one who bad no improvement. Follow-up is from six months to eight years. This minimally invasive outpatient closed Burch-Sling Procedure, utilizing the bladder saver device, allows performance of a time-proven operation with very little morbidity.

 

Conclusion:
There are many references in the medical literature describing nerve injury due to vaginal surgery. The likelihood of damage is greater during traditional incontinence procedures because of extensive anterior vaginal wall dissection.

The unique features of our techniques are the following:

  • It may be performed as an outpatient procedure.
  • Absence of anterior vaginal wall dissection.
  • Use of an endogenous sling for colpo-urethropexy.
  • Cooper’s Ligament is used to anchor the suspension sutures.