The Burch-type COLPOSUSPENSION Dr. Othman Kadry, from Michigan, is presenting his technique of colposuspension for urinary incontinence. Urinary incontinence occurs when the intraabdominal and the intravesicle pressures overcome the urethral closing pressure. The lack of support of the bladder neck and the proximal urethra occurs with relaxation of pelvic fascia and musculature secondary to childbearing, trauma, or the aging process. This results in a change in the normal anatomic relationship of the urethra from a position inside of the abdomen to outside of the abdomen. Thererfore, an increase in abdominal pressure as occurs with sneezing causes urination to occur because the pressure increases in the bladder and squeezes the urine out of the relaxed urethra. The Burch technique is among the many corrective surgical procedures to reposition the urethra. Upon entering the abdominal cavity, the bladder is identified . The retropubic space of Retzius is entered. The bladder and the urethra are carefully diseccted from their retropubic attachment. The retropubic space of Retzius has been disected exposing both Cooper ligaments and the endopelvic fascia. Using a double gloved hand the vagina is pushed up while the instrument exposes the perivaginal fascia. Paraurethral supporting stitches are placed incorporating all but the vaginal mucosa. The sutures are secured to the Cooper's ligament in the Burch procedure seen here. In the Marshall-Marchetti-Krantz operation the supporting sutures are placed in the periosteum of the posterior symphysis pubis. This picture shows how the sutures approximate the paraurethral tissue to the Cooper's ligament. Additional sutures are placed laterally, creating a supporting sling of the anterior wall and elevating the urethra.