ORIGINAL ARTICLE Laparoscopic Burch colposuspension after failed sub-urethral tape procedures: a retrospective audit Eva M. De Cuyper & Rozihan Ismail & Christopher F. Maher Received: 4 July 2007 / Accepted: 5 November 2007 / Published online: 8 December 2007 # International Urogynecology Journal 2007 Abstract Our objective was to evaluate the outcome of laparoscopic Burch colposuspension in women with recurrent stress urinary incontinence after failed primary sub-urethral tape procedures. A total of 16 patients were identified, and their data from symptom-specific ques- tionnaires, urodynamic studies and urogynaecological assessment were collected. At a median follow-up of 24.5 months, objective and subjective cure rates were 54.5% and 92.9%, respectively. Average satisfaction score regarding outcome after surgery was 9.3 on a rating scale from 0 to 10. All but one patient had symptoms of urge incontinence pre-operatively with 64.3% experiencing cure or improvement post-operatively. Voiding difficulties were observed in one patient, and post-operative urodynamics revealed a significant decrease in urinary flow rate (p < 0.05) but with no difference in urinary residuals or maximum urethral closure pressure. Severe peri-urethral fibrosis was identified in 62.5% of the patients. Laparo- scopic Burch colposuspension is an effective and safe surgical option. Keywords Laparoscopic Burch colposuspension . Sub-urethral tape . Recurrent stress urinary incontinence . Re-operation Introduction Polypropylene sub-urethral tape procedures are well estab- lished in the treatment of female stress urinary incontinence [1]. Long-term success rates are equal to the ‘gold standard’ open Burch colposuspension [1, 2]. With the increasing popularity of synthetic sub-urethral tapes, it is inevitable that we will see women presenting with recurrent stress urinary incontinence after failed surgery. Colposuspension after previous failed incontinence surgery has been reported to be a feasible choice to treat patients with recurrent stress urinary incontinence [3–6], although it is believed more likely to fail with increasing number of previous procedures [7, 8]. It has a higher complication rate [3, 9] and can be technically difficult, especially after previous retropubic surgery [6]. A recent meta-analysis comparing laparoscopic and open Burch colposuspension has shown low peri-operative complication rates, shorter hospital stay and faster return to daily activities in favour for the laparoscopic approach and with objective cure equal for both techniques at 5-year follow-up [10]. Two studies have reported on efficacy of laparoscopic colposuspension for recurrent urinary stress incontinence [11, 12]. The authors summarised a wide variety of primary procedures including anterior repairs, colposuspensions, Manchester repairs, needle suspensions, pubovaginal slings and sub-urethral tapes, which make assessment of outcome rates difficult as they may vary with the type of previous surgery. To date, little is known about secondary colposus- Int Urogynecol J (2008) 19:681–685 DOI 10.1007/s00192-007-0506-6 E. M. De Cuyper (*) Department of Urogynaecology, Gold Coast Hospital, Southport, Australia e-mail: evadecuyper@yahoo.com R. Ismail Hospital Kuala Terengganu, Kuala Terengganu, Malaysia C. F. Maher Department of Urogynaecology, Mater, Royals and Wesley Hospital, Brisbane, Australia