Burch Procedure for Stress Incontinence

The Burch procedure is surgery to treat the loss of bladder control (urinary incontinence) in women. Women with urinary incontinence often have urine loss while straining, coughing, sneezing, or laughing. Urinary incontinence may occur because of the bladder and urethra changing position through the course of normal aging or childbirth.

The goal of the Burch procedure is to improve bladder function by providing more support for the urethra and bladder and by restoring them to their normal position.

LET YOUR HEALTH CARE PROVIDER KNOW ABOUT:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Previous problems you or members of your family have had with the use of anesthetics.

  • Any blood disorders you have.

  • Previous surgeries you have had.

  • Medical conditions you have.

RISKS AND COMPLICATIONS

Generally, this is a safe procedure. However, as with any procedure, complications can occur. Possible complications include:

  • Bleeding.

  • Infection.

  • Injury to the bladder, urethra, or surrounding organs.

  • Problems related to the use of anesthetics.

  • You may have difficulty urinating or may have leaking of urine again.

BEFORE THE PROCEDURE

  • Various tests may need to be done before the day of surgery, such as:  

  • Blood tests.  

  • X-rays.  

  • Ultrasonography.  

  • Bladder and urinating tests (urodynamic testing).  

  • Cystoscopy. This is a test to look into your bladder using a small metal scope with a light.  

  • Ask your health care provider about changing or stopping your regular medicines. You may need to stop taking certain medicines, such as aspirin or blood thinners, at least a week before your surgery.  

  • Do not eat or drink anything for 8 hours before your surgery.  

  • If you smoke, do not smoke for at least 2 weeks before surgery. Smokers do not heal as well and tend to have more breathing problems during and after surgery.

  • Make plans to have someone drive you home after your hospital stay. Also arrange for someone to help you with activities during recovery.  

PROCEDURE

  • You will be given a medicine that makes you go to sleep (general anesthetic) or a medicine injected into your spine that numbs your body below the waist (spinal anesthetic).

  • The surgeon may use either a laparoscopic or open technique for this surgery:

  • In the laparoscopic technique, the surgery is done through small cuts (incisions) in the abdomen and groin area. A thin, lighted tube with a tiny camera on the end (laparoscope) is inserted into one of the incisions. The tools needed for the procedure are put through the other incisions. This technique allows for a faster recovery time.

  • In the open technique, the surgery is done through one large incision in the abdomen.

  • Using either technique, the surgeon lifts the wall of the vagina where the urethra is located. The vaginal wall is stitched (sutured) to tissue near the pubic bone. This corrects the weakness so that the bladder remains stable during activities that might cause leakage, such as coughing or sneezing.

  • The incision or incisions will be closed with stitches.

AFTER THE PROCEDURE

  • You will be taken to a recovery area where your progress will be monitored. Once you are awake and stable, you will likely be moved to a regular hospital room.

  • You may have a thin, flexible tube (catheter) in your bladder to drain urine. This may stay in place until your bladder is working properly on its own. The catheter may be removed before you are discharged, or it may stay in place when you go home.

  • You may have gauze or bandages (dressings) in the vagina. This will be removed in 1–2 days.

  • Depending on your condition, you may still have a catheter in place when you go home.

  • If the laparoscopic technique was used, you may be allowed to go home after several hours, or you may need to stay in the hospital overnight. If the open technique was used, you will likely need to stay in the hospital for a couple days.