Advertisement

A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair

      To the Editors:

      We read with interest the article by Colombo et al. (Colombo M, Milani R, Vitobello D, Maggioni A. A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence. Am J Obstet Gynecol 1996;175:78-84). The paravaginal repair is a logical, commonsense approach to anterior vaginal wall anatomic restoration. However, because it lacks comparative clinical data and urodynamic studies, it remains an unproved surgical technique for the treatment of stress urinary incontinence. The Burch colposuspension has become the gold standard, and rightfully so, after years of scrutiny, scientific investigation, and objective analysis.
      In spite of the paravaginal repair's debut 20 years ago, the technique lacks objective analysis.
      • Richardson AC
      • Lyon JB
      • Williams NL.
      A new look at pelvic relaxation.
      To our knowledge, this is the first objective study of the paravaginal repair for the treatment of stress urinary incontinence. We would like to commend the authors for attempting to compare the paravaginal repair to the Burch colposuspension for treatment of stress urinary incontinence. The conclusion that the Burch colposuspension was significantly better than the abdominal paravaginal defect repair in remedying genuine stress urinary incontinence appears appropriate for the results attained; however, it is obvious that the data lack power. We understand and respect that the study was discontinued “because it was no longer considered ethical to propose paravaginal repair for the treatment of genuine stress incontinence,” but, assuming an overall surgical success rate of 85% for standard Burch urethropexies, a total of 160 patients (80 in each group) would be needed to show a difference in success of 12.5% with an α of 0.05 and a power of 0.80.
      The paravaginal repair for stress urinary incontinence resulting from hypermobility in association with a demonstrable lateral tear in the pubocervical fascia remains unproved and should not be excluded from our surgical armamentarium. Colombo et al. should be commended for their objective approach; perhaps their research will prompt others who perform paravaginal repairs on a routine basis to objectively scrutinize their surgical successes.

      References

        • Richardson AC
        • Lyon JB
        • Williams NL.
        A new look at pelvic relaxation.
        Am J Obstet Gynecol. 1976; 126: 568-573