Comparison of Burch Urethropexy and Mid-urethral Sling Performed Concomitantly With a Sacral Colpopexy

NCT ID: NCT00934999

Last Updated: 2023-08-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 113 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-06-30
• Study Completion Date: 2015-10-31

Brief Summary

I. Specific Aims

Pelvic organ prolapse is a common and distressing condition that is frequently associated with stress urinary incontinence (SUI) and often requires surgical repair. Abdominal sacral colpopexy is the preferred operation for repairing pelvic prolapse. As many as 91% of women with pelvic organ prolapse undergoing sacral colpopexy also experience SUI. In addition, up to 44% of previously continent women develop SUI incontinence after sacral colpopexy: perhaps because a sacral colpopexy may predispose to opening of the bladder neck if secured too tightly. The selection of a surgical procedure to prevent and manage SUI in women undergoing sacral colpopexy is empiric rather than evidence-based. Conceptually, a mid-urethral sling may be more effective than a Burch procedure for preventing urinary leakage because a sling provides outlet resistance beyond the bladder neck and therefore it may compensate for a downward tension on the bladder neck resulting from the sacral colpopexy. Indeed, clinical observations suggest that a mid-urethral sling is effective among women who have persistent urinary incontinence after sacral colpopexy with a Burch procedure. Therefore, the investigators' global hypothesis is that a mid-urethral sling is preferable to a Burch procedure for preventing and improving stress urinary incontinence in women undergoing sacral colpopexy for pelvic organ prolapse. The investigators' SPECIFIC AIMS are to evaluate objective and subjective outcomes at 6, 12 and 24 months in 124 women with urinary incontinence and advanced pelvic organ prolapse. All women will be undergoing a sacral colpopexy and will be randomized to either a Burch procedure or a mid-urethral sling. The primary endpoint is composite continence at 6 months while secondary endpoints will include composite continence and subjective measures of incontinence, patient satisfaction and morbidity associated with these procedures. The investigators' hypotheses are as follows:

1. At 6 months, urinary continence rates will be higher after a mid-urethral than after a Burch procedure. Urine continence will be assessed by composite measure of incontinence: no subjective complaint, no interim treatment, and negative standardized stress test performed by a masked observer. This assessment will be repeated at 12 and 24 months post-operatively to establish the medium term continence of the two procedures. Subjective continence and patient satisfaction measures will be obtained at each of the above visits using standardized questionnaires and pelvic organ support will be quantified by Pelvic Organ Prolapse-Quantification (POP-Q) scores.

2. Early events (e.g., blood loss, operative time, intra-operative complications (vascular, bowel and urological injuries), in-hospital complications (need for transfusion, febrile morbidity, thrombotic events, wound infection, length of stay, duration of bladder catheterization and ileus) and delayed postoperative complications (e.g., wound infection, mesh erosion, bowel obstruction and obstructed voiding) will be collected to compare the safety of each procedure.

Conditions

Urinary Incontinence

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Burch

Patients will receive a Burch urethropexy at the time of an abdominal sacral colpopexy.

Group Type: ACTIVE_COMPARATOR

Burch urethropexy

Intervention Type: PROCEDURE

Patients will undergo a Burch modified Tanagho procedure (in which the anterior vagina is suspended to Cooper's ligament bilaterally using two non-absorbable sutures).

Mid-urethral sling

Patients will receive a mid-urethral sling at the time of an abdominal sacral colpopexy.

Group Type: EXPERIMENTAL

Synthetic mid-urethral sling (TVT)

Intervention Type: PROCEDURE

Patients will undergo a polypropylene mid urethral sling as described by the manufacture (Align, Bard Urological, Covington, GA).

Interventions

Burch urethropexy

Patients will undergo a Burch modified Tanagho procedure (in which the anterior vagina is suspended to Cooper's ligament bilaterally using two non-absorbable sutures).

Intervention Type: PROCEDURE

Synthetic mid-urethral sling (TVT)

Patients will undergo a polypropylene mid urethral sling as described by the manufacture (Align, Bard Urological, Covington, GA).

Intervention Type: PROCEDURE

Other Intervention Names

TVT

Eligibility Criteria

Inclusion Criteria

1. older than 21 years of age;

2. with symptomatic pelvic organ prolapse (POP-Q point Aa or C at ≥ -1 cm;

3. who have opted for sacral colpopexy repair of prolapse;

4. who have symptomatic SUI desiring surgical correction or who have occult SUI;

5. who have urethral hypermobility;

6. with a maximal cystometric capacity ≥ 200 cc;

7. who are willing to return for follow-up visit; or

8. who understand and have signed written informed consent to undergo randomization and who has given investigators permission to collect data pertaining to surgical care and follow-up.

Exclusion Criteria

1. with known or suspected disease that affect bladder function (i.e., multiple sclerosis, Parkinson's Disease, spinal cord injury, etc.);

2. who are pregnant by self report or by positive pregnancy test;

3. who desire to maintain fertility;

4. with history of urethral diverticulum;

5. with a history of radical pelvic surgery or pelvic radiation therapy;

6. who are deemed medically poor candidates for abdominal surgery;

7. Non-ambulatory (including those who ambulate with assistance; or

8. who are actively undergoing chemotherapy or radiation treatment for malignancy.

• Minimum Eligible Age: 21 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Spectrum Health Hospitals

OTHER

Sponsor Role: collaborator

Saint Luke's Health System

OTHER

Sponsor Role: collaborator

Mayo Clinic

OTHER

Sponsor Role: lead

Responsible Party

Emanuel Trabuco

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Emanuel C. Trabuco, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

Mayo Clinic

Rochester, Minnesota, United States

Countries

United States

References

Raju R, Madsen AM, Linder BJ, Occhino JA, Gebhart JB, McGree ME, Weaver AL, Trabuco EC. Defining success after surgical treatment of stress urinary incontinence. Am J Obstet Gynecol. 2024 Aug;231(2):235.e1-235.e16. doi: 10.1016/j.ajog.2024.03.034. Epub 2024 Mar 23.

Reference Type: DERIVED

PMID: 38527605 (View on PubMed)

Trabuco EC, Linder BJ, Klingele CJ, Blandon RE, Occhino JA, Weaver AL, McGree ME, Gebhart JB. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol. 2018 Jan;131(1):31-38. doi: 10.1097/AOG.0000000000002415.

Reference Type: DERIVED

PMID: 29215517 (View on PubMed)

Other Identifiers

94021001

Identifier Type: -

Identifier Source: secondary_id

07-007334

Identifier Type: -

Identifier Source: org_study_id