Laparoscopic Burch Colposuspension Versus Transobturator Tape for the Treatment of Stress Urinary Incontinence in Egyptian Women: A 12‐Month Randomized Controlled Trial

Abstract

AIMS: This study aimed to compare the efficacy, safety, and patient-reported outcomes of laparoscopic Burch colposuspension versus the transobturator tape (TOT) midurethral sling procedure for treating stress urinary incontinence (SUI) in Egyptian women. METHODS: This was a randomized, open-label clinical trial conducted in Assiut, Egypt between January 2021 and December 2023. Fifty-two women with SUI were randomly assigned to two groups of 26 patients each: Group A underwent the TOT procedure, and Group B underwent laparoscopic Burch colposuspension. The primary outcome was the improvement of SUI, assessed by a cough stress test. Secondary outcomes included changes in symptom severity and quality of life, measured by the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Patients were evaluated at 3, 6, and 12 months postoperatively. RESULTS: Operative and anesthesia times were significantly longer for the laparoscopic colposuspension group (p < 0.001). At 12 months, the treatment failure rate was significantly higher in the colposuspension group (34.6%) compared to the TOT group (7.7%) (p = 0.017). While both groups initially improved, the SUI subscale scores on the UDI-6 for the colposuspension group worsened after 3 months, becoming significantly worse than the TOT group at 6 and 12 months (p = 0.004 at 12 months). Similarly, at 12 months, the TOT group reported significantly better quality-of-life scores on the IIQ-7 (p = 0.04). Multivariate binary logistic regression identified laparoscopic Burch colposuspension as a significant predictor of treatment failure (Odds Ratio: 7.02, p = 0.01). Overactive bladder was more common after TOT, whereas recurrence was more frequent after colposuspension (p = 0.02). CONCLUSIONS: While both procedures initially improve SUI, the TOT procedure provides superior and more sustained efficacy over a 12-month period in this cohort of Egyptian women. The TOT group had a significantly lower treatment failure rate and better patient-reported quality-of-life outcomes. Although associated with de novo overactive bladder and groin pain, the higher success rate of TOT suggests it may be a more reliable surgical option for SUI. CLINICALTRIALS: gov registration number: NCT04775186.