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Burch colposuspension vs MMK procedure

StudyStudy type and ELNo. of patientsPatient characteristicsInterventionComparisonLength of follow-upOutcome measuresEffect sizeAdditional comments
McCrery 2005636SB RCT
EL = 1+
138 with > 6 months follow-up, n randomised unclearF mean age ~48–51 (29–77), stress UI and anterior wall prolapse, with urethral hypermobility (Q-tip > 30° from horizontal)
UD diagnosis in 64%: 78% stress UI, 22% mixed UI
Exclusions: prior continence surgery, cough LPP < 60, or MUCP < 20
Open Burch colposuspension* (n = 66)MMK* (n = 72)Mean 24 months (7–55) Burch grp, 28.8 (6–60) MMK grpSubjective cure/ improvement/ failureITT analysis:
59.1 vs 48.6% cure
25.8 vs 15.3% improvement
15.2 vs 36.1% failure P = 0.02
Excluding losses to follow-up:
65 vs 57.4% cure
28.3 vs 18.0% improvement
6.7 vs 24.6% failure P = 0.02
In 64% who had pre-op UD:
ITT analysis:
14 vs 42.2% failure P = 0.005
Excluding losses to follow-up:
10% vs 35% P = 0.008
Funding: none declared.
Randomisation by coin toss in the operating room.
9% vs 15% lost to follow-up.
*both with concomitant paravaginal defect repair; 55% vs 68% also had hysterectomy, 30% vs 33% abdominal sacral colpopexy, 50% vs 49% posterior repair, 33% vs 30% abdominal cystocele repair, 82% vs 85% culdoplasty.
Colombo 1994637
Colombo 1998949 reported long-term follow-up of the MMK group (and another 29 pts)**
RCT
EL = 1+
80F mean age ~50–51 years, UD stress UI with moderate or severe symptoms (daily leakage episodes range 13–21)
Exclusions: MUCP < 30, DO, POP 2nd degree or greater, urethral diverticula, urogenital fistulas, prior failed continence surgery
Open Burch colposuspension (n = 40)Modified MMK (n = 40)2–7 years (mean 3.1 Burch, 3.5 MMK)Objective cure (negative stress test)80% vs 65%, P = NSFunding: none declared.
*reduction in severity score of ≥ 50%.
35% vs 20% had concomitant culdoplasty.
Subjective cure or improvement*Cure 92% vs 85%, P = NS
Improvement 8% vs 15%
Hospital parameters (mean, SD)Days catheterisation 8.5 (7) vs 13.4 (6.9), P = 0.002
Days hospital stay 6.3 (1.4) vs 7.4 (1.5), P = 0.001
Complications0% vs 5% haematoma
5% vs 10% de novo DO (2.5% vs 10% urge UI)
Long-term complications in MMK grp (n = 69)** at mean follow-up 4.2 years949MMK grp only:
19% voiding difficulties
9% worsening of pre-existing urge UI
7% de novo DO
7% chronic urinary retention (6% had urethral dilation)
7% developed genital prolapse
3% recurrent UTI
Quadri 1999638RCT
EL = 1+
30F mean age 58 vs 63 years, stress UI with low urethral pressure (MUCP ≤ 20), and hypermobility ( > 30° on Q-tip)
23% had prior vaginal surgery for anterior vaginal prolapse and stress UI
Open Burch colposuspension (n = 15)MMK (n = 15)1 yearObjective cure (negative stress test)80% vs 86% at 2 months
53% vs 93% at 1 year, P = 0.017
Funding: none declared.
Abstract publication of study included in Cochrane review.638
MMK under cystoscopic control.
Sig. difference in ‘flow times’ at baseline, 232.2 vs 14.1 s, P = 0.004.
Procedures performed by 2 surgeons.
Subjective cure80% vs 100% at 2 months
66% vs 100% at 1 year, P = 0.02
Complications7% vs 20% cystitis
13% vs 13% fever
mean (SD) time to normal voiding 6.5 (3.3) vs 20.5 (13.4) days, P < 0.001
Liapis 1996639
Liapis 1996950 reports Burch and AC arms only at 3 year follow-up; n = 81) – data not reproduced here, believed to be the same patients as in
RCT
EL = 1−
170 randomised, 155 (91%) followed to 5 yearsF mean age 51 years (36–75) UD stress UIBurch colposuspension* (n = 54)MMK* (n = 51)
Anterior colporrhaphy* (with Kelly plication, n = 50)
4 yearsObjective and subjective cure (no definition, other than ‘by urodynamic study’95 vs 85% vs 78% at 2 months
89 vs 67% vs 56% at 4 years (P < 0.001 for Burch grp vs others)
Funding: none declared.
[EL = 1−] No baseline data or comparisons for grps; no definition of urodynamic cure; only completers analysed; differences in other procedures undertaken.
*posterior colporrhaphy also performed in Burch and AC grps; and in MMK if ‘there was a degree if rectocele’ (n not stated).
Complications/ adverse effects7 vs 14% vs 10% de novo DO
4 vs 6% vs 6% urge UI

From: Evidence tables for included studies

Cover of Urinary Incontinence
Urinary Incontinence: The Management of Urinary Incontinence in Women.
NICE Clinical Guidelines, No. 40.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2006 Oct.
Copyright © 2006, National Collaborating Centre for Women’s and Children’s Health.

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