Laparoscopic Burch colposuspension

Summary

A Burch colposuspension is an operation for stress urinary incontinence — leaking urine when you cough, sneeze, laugh, lift or exercise. Permanent stitches lift the tissue on either side of the bladder neck and anchor it to the strong ligament behind the front of the pelvic bone, restoring the support that has been lost, so the bladder neck stays closed when pressure rises. In the laparoscopic (keyhole) approach this is done through small cuts rather than an abdominal incision.

• It treats leaking on effort. It does not treat the sudden, urgent need to pass urine — that is a different problem, treated differently.
• Done under general anaesthetic through four small cuts (one 10 mm and three 5 mm), and usually takes one to two hours.
• It uses permanent stitches only — no mesh or tape is implanted.
• Colposuspension is the longest-established operation for stress incontinence, with the longest published follow-up of any technique.
• A catheter is placed at the end of the operation, because urine can be held up or slow to pass for a few days after the support is tightened.
• Avoid heavy lifting and straining for 4–6 weeks so the stitches hold while healing.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

Stress incontinence happens when the support beneath the bladder neck and upper urethra has become slack — commonly after childbirth, with age, or after heavy physical work — so a cough or a lift pushes the bladder neck down and urine escapes.

A colposuspension restores that support. The surgeon enters the space behind the pubic bone, and places two or three permanent stitches on each side, through the strong vaginal wall tissue beside the bladder neck and up into the iliopectineal ligament (Cooper's ligament) on the back of the pubic bone. Tying these lifts the bladder neck into its normal position and holds it there. No tissue is removed in this operation, and no mesh or synthetic tape is used.

The same operation can be done three ways: laparoscopically (keyhole, through small cuts), open (through a bikini-line incision), or robotically. The stitches and the principle are identical; the keyhole route avoids the larger wound, so there is less pain and a quicker return to normal life.

Why it is performed

Surgery is considered for stress incontinence that is troubling you and has not improved enough with the other treatments that come first. Colposuspension is our usual choice of operation for stress incontinence. It is offered when:

• Supervised pelvic floor muscle training — a proper course, not a few exercises — has not given you enough improvement
• Leaking is affecting your daily life: work, exercise, travel, sleep or confidence
• Tests confirm the leak is stress incontinence rather than an overactive bladder, or the two are separated out where both are present
• You are also having another pelvic operation where the same access is used, and the bladder neck can be supported at the same time

Before surgery your bladder is assessed — a bladder diary, a urine test to exclude infection, checking how well you empty, and, in selected cases, urodynamic testing (bladder pressure studies) to confirm the type of incontinence. Operating on the wrong type does not help, so this assessment matters.

Benefits

• Leaking on effort stops or greatly improves in the large majority of women — the point of the operation is being able to cough, lift, run or laugh without leaking.
• No mesh or tape. The repair is made with permanent stitches, so the specific complications associated with synthetic slings do not apply.
• The longest track record. Colposuspension has been studied for longer than any other continence operation, so its long-term results are well documented.
• Compared with the open operation: smaller cuts, less pain, a shorter stay and a faster return to normal activity, with the same stitches placed in the same places.
• Occasionally combined with other pelvic surgery in one anaesthetic, where that is appropriate for you.

Alternatives

• Supervised pelvic floor muscle training — a properly taught and supervised course over at least three months. This comes first for everyone, and for many women it is enough.
• Lifestyle measures — weight reduction where relevant, treating a chronic cough or constipation, and adjusting caffeine and fluid habits; each reduces the pressure that causes the leak.
• Vaginal pessary or support device — for occasional situations such as exercise.
• Mid-urethral sling (TVT/TOT) — a synthetic tape supporting the mid-urethra. Effective and quicker to recover from, but mesh procedures now carry restrictions and specific safety considerations that are discussed separately.
• Doing nothing for now — managing with pads and pelvic floor exercises while you decide takes nothing away from later surgery.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure checks, and a review of your medicines and general health, alongside the bladder assessment described above. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery, especially previous continence or prolapse operations, or previous caesareans, since these change the space behind the pubic bone.

• Urine infection must be treated before surgery.
• Obesity, cough and constipation: anything that raises abdominal pressure works against the repair. Treating a chronic cough or constipation beforehand protects the stitches.
• Smoking: stopping even a few weeks before surgery reduces chest and wound complications, and reduces the cough that strains the repair.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first two weeks and plan to avoid lifting — including water containers, wet washing and children.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including the possibility of slow bladder emptying afterwards, of new urgency, and of what should happen if unexpected findings are encountered. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots, and antibiotics are given at the start of surgery.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. A catheter is placed to keep the bladder empty and to let the surgeon identify the bladder neck accurately.

The abdomen is gently inflated with carbon dioxide gas to create space to operate. Four small cuts are used — one of 10 mm for the camera and three of 5 mm for the instruments. Working through the abdominal cavity (the transperitoneal approach), the surgeon opens the space behind the pubic bone and clears the fatty tissue to expose the vaginal wall beside the bladder neck and the iliopectineal ligament above it. Two or three permanent stitches are then placed on each side, through the vaginal wall tissue and into the ligament, and tied so that the bladder neck is lifted into position — deliberately supported, not pulled tight, since over-correction is what causes difficulty passing urine afterwards. The gas is let out and the small cuts closed with dissolvable stitches. The operation usually takes one to two hours.

Occasionally, if keyhole surgery proves unsafe to continue — for example because of dense scarring from previous surgery, or bleeding in that space — the surgeon completes the operation as an open operation for your safety. This is rare.

After the operation

By the time you wake, the operation is complete. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own; walking about helps.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• The catheter: removed the day after surgery. The team then checks that you are passing urine satisfactorily — after the bladder neck has been supported, this can be slow for a few days. If it is, the catheter is kept for longer or you are taught to pass a catheter yourself for a short period. This is expected, temporary, and not a sign the operation has failed.
• Eating and drinking: usually the same day, starting with fluids; the team will guide you as you become comfortable.
• Moving: up and about the same day or the next morning — early walking speeds recovery and protects against clots.
• Going home: usually the day after surgery, once you are comfortable and passing urine satisfactorily; some women stay a second day.

Recovery at home

• Week 1: rest, alongside your normal day-to-day activities. Tiredness is normal.
• Week 2 onwards: build your daily activity up steadily; most women manage as they did before.
• Lifting and straining: avoid both for 4–6 weeks — this is the single most important instruction, because pressure on a healing repair is what loosens it. Treat constipation promptly.
• Driving: once you can brake hard without hesitation — commonly around 2 weeks.
• Sex: usually after about 6 weeks, when you are comfortable.
• Exercise: walking and swimming first; high-impact exercise and heavy gym work from about 6 weeks, guided by your consultant.
• Pelvic floor exercises: usually restarted once healing allows — they protect the result long-term.
• Passing urine: a slower or different stream in the early weeks is common and usually settles. Tell the team if you feel you are not emptying completely.

This guidance covers what is usual after keyhole surgery; the advice given to you personally takes precedence.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on your age, weight, other conditions and previous surgery, and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first days; shoulder-tip pain from the gas
• Bruising around the small cuts
• A slower urine stream, and needing to give the bladder time to empty, in the early weeks

Complications

• Difficulty emptying the bladder — the commonest problem after this operation. Usually short-lived and managed with a catheter for a few days; occasionally it lasts longer and needs self-catheterisation for a period, and very rarely the stitches need loosening.
• New or worse urgency (overactive bladder) — a sudden need to rush to the toilet that was not there before, or was minor before. This can develop after the bladder neck is supported and is treated with bladder retraining and medication if needed.
• Urine infection — common after any bladder surgery or catheter use, and treated with antibiotics.
• Injury to the bladder or ureters — recognised injuries are repaired at the time (a rare complication).
• Bleeding in the space behind the pubic bone, occasionally needing drainage or transfusion (a rare complication).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (a rare complication).
• Prolapse developing later — supporting the front of the vagina can leave the back wall or the top relatively unsupported, so a prolapse can appear there in later years (a rare complication).
• Leaking returning over time — tissue support weakens with the years, so the leak can recur; some women need further treatment later.
• Pain over the pubic bone where the stitches are anchored (a rare complication).
• Conversion to open surgery during the operation, for safety (rare).
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Being unable to pass urine, or passing only small amounts with a full, uncomfortable bladder — this needs attention promptly
• Burning on passing urine, or blood in the urine that does not settle
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening lower abdominal pain not controlled by your painkillers
• A wound that becomes red, swollen, hot or leaks fluid
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this operation is recommended for you rather than a sling or further physiotherapy, and which risks matter most in your case — particularly the chance of slow bladder emptying and of new urgency. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. Available from: https://www.nice.org.uk/guidance/ng123 [last checked 29 July 2026].
2. Royal College of Obstetricians and Gynaecologists. Consent advice — browse all guidance. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 29 July 2026].
3. National Health Service (UK). Urinary incontinence — surgery and procedures. Available from: https://www.nhs.uk/conditions/urinary-incontinence/surgery/ [last checked 29 July 2026].

Patient information from our own clinics

There is no Sugabi or vog.lk article on this topic yet. Related reading:

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