Extrusion to urethra, bladder or vagina is a known complication in the use of synthetic suburethral mesh (SUM) for the treatment of female stress urinary incontinence (SUI). If subsequent surgical treatments are needed, the use of synthetic material should be avoided. In this scenario other techniques can be used, such as Burch's colposuspension, which was the gold standard before the appearance of SUM.

We present the case of an 89-year-old woman, in excellent general condition, with a history of open hysterectomy. In 2016, a TOT was placed which was endoscopically resected in 2019 and 2022, because of bladder extrusion, with  reappearance of SUI. After ruling out new extrusions and given the previous complications with the synthetic material and previous abdominal surgery, an extraperitoneal laparoscopic Burch colposuspension was indicated.

In Lloyd-Daves position, an infraumbilical minilaparotomy is performed and the extraperitoneal plane is developed with the help of a Gaur balloon. An optical trocar and three 5 mm trocars are placed in the midline and both iliac fossas. The space of Retzius is dissected identifying the urethra, bladder neck, anterior vaginal wall, pubis and Cooper's ligaments. 2 suspension non-absorbable stitches are placed connecting the anterior vaginal wall and Cooper's ligament, one at the level of the bladder neck and the other at the distal third of the urethra, all adjusted using the sliding hem-o-lock technique. The absence of extrusion of suture threads in the urethra and bladder is ruled out by a final cystoscopy.
The intervention time was 90 minutes. No intra- or post-operative complications were recorded, being discharged at 48 hours.  At 2 month SUI resolved with no need of pad use.

Burch's colposuspension was once the gold standard surgical technique for SUI. Nowadays it can be used in cases where the use of synthetic suburethral mesh is contraindicated. This technique can be minimally invasively performed and with an extraperitoneal approach that allows to avoid altered surgical fields by previous surgeries.

Continence 12S (2024) 101529
DOI: 10.1016/j.cont.2024.101529