Surgical treatment of stress urinary incontinence: comparison of robotic-assisted Burch urethropexy with retropubic midurethral sling

Abstract

Synthetic retropubic midurethral slings (RMUS) and robotic-assisted Burch urethropexies (RA-Burch) are common surgical treatment options for stress urinary incontinence (SUI). Few data exist comparing the success of these two retropubic surgeries. This retrospective cohort study of RA-Burch and RMUS procedures compared the proportion of patients with subjective cure after RA-Burch compared to RMUS at our institution between 2016 and 2020. Subjective cure was defined as reporting no symptoms of SUI at longest follow-up. Chi-square, Fisher's exact, Mann-Whitney U tests, logistic regression, and Kaplan-Meier log-rank tests were used in analyses. The overall cohort of 235 subjects included 47 RA-Burch cases matched 1:4 with 188 RMUS cases. Patients who underwent RA-Burch were younger (p < .01), had lower BMIs (p = .04), and were more likely to have concomitant procedures, including hysterectomy (p < .01). There was no difference in subjective cure at longest follow-up (p = .76). Median follow-up was longer in the RA-Burch group (p < .01). There was no difference in early postoperative complications, EBL, treatment for persistent SUI, or new urge urinary incontinence at longest follow-up. Both groups experienced postoperative urinary retention at a similar rate, although 4 RMUS patients required sling lysis and one patient experienced a mesh exposure. Patients undergoing RA-Burch had significantly longer OR times when no concomitant procedure was performed (p < .01). There were no significant predictors of SUI recurrence when controlling for baseline variables. This study suggests that RA-Burch and RMUS may be equally efficacious for patients with symptoms of SUI desiring surgical management.

Keywords: Burch; Robot-assisted surgery; Robotic-assisted Burch urethropexy; Urethropexy.