Which procedure involves fixing the anterior vaginal wall to the ligament of Cooper?

• A. Bulking injection
• B. Burch Colposuspension
• C. Suburethral sling
• D. Artificial sphincter

Answer: (B)

Fixing the anterior vaginal wall to the ligament of Cooper is a retropubic urethropexy known as Burch colposuspension. By attaching the anterior vaginal wall to the pectineal (Cooper’s) ligament, the bladder neck and urethra are elevated and stabilized. This reduces urethral mobility when there’s a rise in abdominal pressure, thereby increasing urethral outlet resistance and preventing stress incontinence.

Bulking injections add bulk to the urethral mucosa rather than providing a fixed support to the pelvic ligaments. A suburethral sling creates a new support under the urethra but doesn’t specifically fix the anterior vaginal wall to Cooper’s ligament. An artificial sphincter provides a controllable mechanical valve but is not a fixation to the ligament.