Laparoscopic TOT-like Burch colposuspension: a modification of the original to adapt to the future

: Urinary incontinence is a medical condition that decreases the quality of life of more than 35% of women worldwide and its incidence increases with age. Since their introduction in 1996, the transvaginal midurethral slings have become the treatment of choice for patients with stress urinary incontinence. In recent years the restriction of the United States Food and Drugs Administration over the transvaginal meshes for prolapse has generated considerable tension and debate over the synthetic protheses, applied to the patients via transvaginal route either for prolapse, or incontinence. Due to growing concerns over a complete ban of transvaginal tapes for incontinence in the future, gynecologists have rediscovered the Burch colposuspension for treatment of patients with incontinence. The procedure is living its renaissance and the goal of this article is to present our modification of the classical technique that we call TOT-like Burch colposuspension using a state-of-art laparoscopic approach. One of the drawbacks of the classic Burch procedure is the high rate of dysuric symptoms postoperatively, which in our modification is overcome, as the suspension of the bladder neck and the urethra includes also the pubourethral ligaments and the arcus tendinous fascia pelvis with a single suture, which provides the tension-free support resembling the effect of the TOT-tapes. The corresponding video is divided in different steps in order to make the procedure more comprehensive and reproducible. 5