Burch Colposuspension Surgery:
The Burch Colposuspension has become the gold standard for the treatment of Urinary Incontinence due to weakness of the bladder neck since it was first reported in 1968. It is caused by childbirth, congenital factors and the tissue weakness associated with the menopause. It usually causes the symptoms of stress, cough or sneeze induced leakage. The surgeons from the St. George Urodynamic centre have performed over 1000 of these procedures with a success rate of around 90%. Since 1991 we have been performing this procedure using the new techniques of advanced laparoscopic or keyhole surgery with exactly the same results (Aust NZ J Ob/Gyn 1996; 36:1:44). The operation involves the stitching of the bladder neck to the ligaments at the back of the pubic bone. This prevents the bladder valve from dropping during a cough, which would cause it to open up and lose urine.

Disadvantages of Traditional Surgery:
The traditional operation involves a 10-15 cm "bikini cut" incision, a considerable amount of postoperative pain requiring intramuscular or intravenous narcotic analgesia, prolonged postoperative catheter drainage, and worst of all, a 7-10 day hospital stay and 4-6 weeks off work at least. This meant that many women had to persevere with their symptoms rather than commit to this major abdominal surgery and prolonged convalescence.

Laparoscopic Surgery:
In our study of 113 Laparoscopic Burch Colposuspensions recently published we found that the same operation could be performed without incisions using the keyhole approach. Laparoscopy uses a TV camera on the end of a telescope introduced through a 1-cm puncture in the navel. This projects the operation site onto a monitor screen. Newly developed instruments are introduced through 2 other tiny nicks in the skin to dissect down to the area around the bladder neck so that it can be stitched to the pubic bone ligaments.

We also found that because there was no large incision there was very little post operative pain and therefore little need for post operative catheter drainage with a bag to establish early normal voiding. The average patient went home on the 3^rd postoperative day without a catheter and was back at work in 1-2 weeks. A percentage of patients required catheterisation for longer than 48 hours, and more than half of these still went home very early with the very modern forms of simple bladder drainage using either clean intermittent self catheterisation or a simple suprapubic catheter removed in the office at 1 week. Self-catheterisation will be taught to you immediately after your temporary catheter comes out the next morning. You can read all about this in detail by reading the postoperative instruction leaflet that will be given to you.

Complications are similar to those of the open operation except that the incidence of wound infection is drastically reduced. These include those of any general anaesthesia and major pelvic operation including infection, thrombosis and inadvertent injury to bladder, bowel or major vessels. If for any reason we felt that the operation could not be completed satisfactorily for technical reasons or because of complications then it would be completed by open operation or laparotomy, and this is assumed in your consent.

Post operatively you will have some sutures that have to be removed on 5-7 by the ward sister or your GP if this is easier. All severe forms of exertion and intercourse are restricted for 1 month after your operation but you can drive a car as soon as you get home and perform light household duties and low impact exercise. You can usually go back to work in 1-2 weeks. A follow up visit is required 4-6 weeks after your operation.