Stress urinary incontinence (SUI) in women is a disease associated with the functional failure of the anterior vaginal wall and paravaginal tissues. SUI occurs quite often, especially in patients with complicated childbirth, postpartum incompetence of the pelvic floor muscles and postmenopause. The problem of SUI extremely disrupts the lives of patients, especially during the reproductive period, creating severe medical, social and psychological problems for each patient.
In the 21st century, sling operations were chosen as the gold standard for the treatment of SUI, but the concept is currently being revised. Along with the obvious unpleasant complications of using mesh implants, such as erosion of the mesh prosthesis and aseptic inflammation in the area of implantation, there is a tendency to fibrosis in the area of the prosthesis, urination difficulties as a result of overcorrection, as well as the impossibility of repeated surgery both when the desired result is not achieved, and when the formed age-related changes in the long term.

20 patients of reproductive age with SUI and coexistent prolapse or urethral malposition or hypermobility form were selected, planning to further implement their reproductive function. The study period is from May 2023. The patients filled out informed consent to participate in the study. To correct stress urinary incontinence, the method of laparoscopic colpopexy using the Birch method was chosen. For correction, a synthetic non-absorbable braided polyamide suture USP 4/0 was used. The quality of sexual life was assessed using The Female Sexual Function Index. Ultrasound intraoperatively was used to determine the degree of tissue tension.

The average age of the patients was 36.0[32.0; 41.0]. The number of pregnancies was 4.0[3.0;5.0], the number of births was 3.0[3.0;4.0], the time from the onset of the disease was 36.0[30.0;54.0] months. Among all patients, stage 1 pelvic organ prolapse according to the POP-Q classification was diagnosed in 16 cases; pelvic organ prolapse was absent in 4 patients. The duration of the operation was 66.0[54.0;78.0] minutes, blood loss was small - 90.0[60.0;180.0] ml, the postoperative period was without complications in all patients, the time of hospital stay was recorded 3.0[3.0;4.0] days. In all patients, correction of urological disorders was carried out in full and did not have negative consequences during the observation period. FSFI results 1 month after surgery 26.0 [24.0; 30.0]. 2 patients became pregnant and were successfully delivered by cesarean section without complications.

The Birch operation is a safe and effective method for correcting stress urinary incontinence in patients of different ages and has advantages in terms of correcting these disorders in women of reproductive age. The use of the Burch procedure allows for correction of SUI without the use of mesh implants and avoids complications associated with them. The use of ultrasound control to determine the degree of thread tension provides the most correct anatomical and functional result.

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Karadag MA, Demir F, Sonmez G, Keske M. Multiple Endoclip Retraction Technique (MERT) in Laparoscopic Burch. JSLS. 2022 Jul-Sep;26(3):e2022.00034. doi: 10.4293/JSLS.2022.00034. PMID: 36071999; PMCID: PMC9439286.