Colposuspension success and failure: a long-term objective follow-up study.

The Burch colposuspension is regarded as one of the most successful procedures for the operative treatment of genuine stress incontinence. In this study the authors have attempted to define long-term subjective and objective success rates. Of 121 patients operated on between 1985 and 1995, 83 were fully assessed: 77% (64/83) had no stress leakage, but 41% (34/83) were suffering from urge incontinence. On clinical assessment 6 cases of uterine prolapse or vault descent, 21 cystoceles (25%) and 47 rectoceles or rectoenteroceles (57%) were detected, all but 8 being asymptomatic. On ultrasound 64/83 patients (77%) had a normal result. Ten patients demonstrated bladder neck hypermobility and in 9 there was urethral funneling without hypermobility. Survival analysis showed that the likelihood of all types of failure and of abnormal ultrasound findings increased over time. It is proposed that long-term results after incontinence surgery be presented as survival analysis.