Laparoscopic Burch procedure for stress urinary incontinence: the Carter modification.

Bladder neck suspension is now possible under laparoscopic control. The advantages of laparoscopy now apply to laparoscopic colposuspension. The technique described in this paper simplifies the laparoscopic Burch procedure by utilizing the harmonic scalpel for dissection of space of Retzius in a sharp and blunt fashion, providing for a bloodless dissection of the space, suturing of the perivaginal tissue avoiding penetration of the vaginal mucosa, placing the Stamey needle through a small skin incision, allowing for a variation in the shape of the pelvic bone so that the dissection of Cooper's ligament is performed in a very atraumatic fashion, extracorporeal knotting of the suture for ease of fixation of the perivaginal fascia to the Cooper's ligament and stapling of the peritoneal surface for reclosure of the space. With the adoption of this technique, the procedure of laparoscopic bladder suspension can be performed in most cases in approximately 1 hour of surgical time. The results are very encouraging, and the procedure as described in fact does not differ from the classical Burch procedure in any significant detail. Therefore, the long-term results are expected to be similar to those obtained by the standard Burch approach. No failures have thus far occurred in 50 patients over two years follow up. One patient did require urinary drainage through the suprapubic catheter for a period of one week prior to ability to avoid spontaneously.