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.


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.