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

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.