OUTPATIENT BURCH-SLING PROCEDURE --
A NERVE SPARING METHOD FOR CORRECTION OF FEMALE URINARY INCONTINENCE (abstract)

BACKGROUND :
This is a report of a new technique and experience performing Outpatient Burch-Sling with No Laparotomy or Laparoscopy as a Nerve Sparing Technique. The purpose of this operation is to describe the surgical approach to genuine stress urinary incontinence, which hopefully will prevent injuries to somatic nerve fibers:

•  External urethral sphincter nerve

•  Dorsal nerve of clitoris

•  Posterior nerve of labia majora

•  Posterior nerve of labia minora, plus

•  Vaginal nerves from autononilc nerve division

TECHNIQUE :
The procedure is a retropubic bladder neck suspension using a newly invented bladder saver device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction. This repositions the proximal urethra within the abdominal cavity toward Cooper's Ligament with permanent sutures. In this method the vaginal wall is used as an endogenous suburethral sling .

EXPERIENCE :
Fifty eight cases have been performed with no major complications and only one who bad no improvement. Follow-up is from six months to eight years. This minimally invasive outpatient closed Burch-Sling Procedure, utilizing the bladder saver device, allows performance of a time-proven operation with very little morbidity .

Conclusion:
There are many references in the medical literature describing nerve injury due to vaginal surgery. The likelihood of damage is greater during traditional incontinence procedures because of extensive anterior vaginal wall dissection.

The unique features of our techniques are the following:

* It may be performed as an outpatient procedure.
* Absence of anterior vaginal wall dissection.
* Use of an endogenous sling for colpo-urethropexy.
* Cooper’s Ligament is used to anchor the suspension sutures.

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