Thus, if we had performed a Burch urethropexy in all patients undergoing ASC, an unindicated Burch procedure
would have been performed in more than 80% of patients undergoing ASC, subjecting them to unnecessary additional complication risks, including de novo lower urinary tract symptoms.
I no longer perform the Burch procedure
. I do a sling procedure if the patient has overt stress urinary incontinence, but not if her incontinence is occult.
(1,2) The mid-urethral sling (MUS) procedures were developed in an effort to provide patients with a less invasive therapeutic option for surgical treatment of SUI than the traditional sling and Burch procedures
, without compromising efficacy.
Concern that the Burch procedure
might increase the risk of urge incontinence or other urinary symptoms, or that it might create an unnecessary surgical risk in those patients who would not have developed postsacrocolpopexy stress incontinence, appears unfounded.
When compared with the traditional bladder neck sling and the use of tension free vaginal tape (TVT), the Burch procedure
also compared favorably.
For patients with intrinsic sphincteric deficiency (ISD) and a mobile urethra, or for patients with a normal urethra, he suggests a Burch procedure
or sling, depending on comorbidities.
Some studies of retropubic repairs for cystocele show great cure rates, but the laparoscopic Burch procedure
may be a better choice if the patient has stress incontinence, Dr.
Walters compared data on 72 patients who underwent a TVT procedure or a laparoscopic Burch procedure
at two institutions in an ongoing study.
That's why the quoted high initial success rates-often 80%-90%--for the Burch procedure
, variations on the pubovaginal sling operations, needle suspensions, and other traditional procedures often give way to a mere 50% or so long-term cure rate without subsequent problems.
Modifier -59 is used for distinct and independent surgical services on the same day For example, this could be used for a Burch procedure
performed transabdominally for stress incontinence at the same time as a posterior colporrhaphy is done for defecation dysfunction.
Abdominal retropubic urethropexy via either the Burch procedure
or the Marshall-Marchetti-Krantz (MMK) procedure is the operation of choice for women with genuine stress incontinence due to a hypermobile urethrovesical junction in the presence of a normally functioning urethral sphincter.
In addition, patients undergoing the Burch procedure
were significantly more likely to be having their first anti-incontinence procedure (90% vs.