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Objectives: The minimal surgical treatment of stress urinary incontinence with endoscopic operation has four basic advantages compared with traditional open procedures: decreased blood loss due to better visualization of the space of Retzius, decreased postoperative pain, shorter hospitalization and faster recovery. Comparative studies have shown a higher subjective and objective cure rate for the retropubic urethropexy(Burch procedure) than for the anterior colporraphy or endoscopic needle urethropexy(1). The aim of this study is to evaluate the safety, the efficacy and morbility of laparoscopic Burch procedure for the surgical treatment of genuine stress incontinence. Methods: We reviewed the results of 87 patients who underwent L.B. between 1997 and 2003 by the same surgeon. The main age was 52 years (range 42-71), the mean body weight was 65 Kg.(range 50-73) and the mean parity was 3 (range 1-5) . 55 post menopausal pts. (63,5%) were taken a systemic or local estrogen therapy. All pts. preoperativelly underwent a complete urogynaecological work-up (Q tip test, Vaginal profile, Pad test, Urodynamic investigation and Urethrocystoscopy). All the pts. showed S.U.I. mainly grade II (according to Ingelman Sundeberg) and urethral hypermobility nearly always associated with cystocele of I-II degree and uterus-prolapse or vault prolapse of different degree. For this reason we performed associated laparoscopic procedures like total hysterectomy on 52 pts(60%), Mc Call culdoplasty on 70 pts (80%), paravaginal repair on 35 pts (40%) and colposacropexy on 24 pts.(28%). We perfomed LPS Burch alone on 10 of the patients (9%). A follow-up questionaire on urinary function and quality of life was obtained. Results: The main operative time for L.B. was 67 minutes (range 40-120), estimated blood loss was minimum and mean hospital stay was 24 hours. The foley catheter was removed after 6-12 h. No bladder or uretheral injures occurred. At 5 years followup 60 pts (69%) were continent, 5 pts. (5.7%) de novo instability, 6 pts (%) were somewhat improved and 17 pts were complete failures. Conclusions: Laparoscopic Burch procedure seems to be a feasible alternative to the open Burch today for a different and less traumatic approach, for a lower morbility and for a shorter hospital stay

Study Objective To compare two techniques of transperitoneal laparoscopic urethropexy. Design Prospective, randomized, open trial (Canadian Task Force classification I). Setting University-affiliated department of gynecology and obstetrics. Patients Sixty women with genuine stress incontinence. Interventions Transperitoneal laparoscopic retropubic urethropexy using nonabsorbable sutures (group A) and polypropylene mesh fixed with tacks or staples (group B). Measurements and Main Results Failure was assessed subjectively and objectively. Subjective evaluation was performed asking patients if they had urine loss and having them describe symptomatology on a visual analog scale before surgery and at each follow-up visit. Objective evaluation was by clinical examination and/or multichannel urodynamic studies. No significant differences in intraoperative and postoperative complications were observed between groups. The subjective failure rate was not significantly different between groups 3, 6, and 12 months after surgery. At 3 and 6 months the objective failure rate was not significantly different; however, at 12 months it was significantly lower in group A than in group B. Conclusion Transperitoneal laparoscopic retropubic urethropexy is more effective with sutures than with mesh.