WebMD Medical News
Louise Chang, MD
May 22, 2007 -- Researchers have new information on what type of
bladder-control surgery may work best for women with urinary stress
Urinary incontinence, losing urine by accident, can happen for various
reasons. Stress incontinence is caused by physical activities such as exercise,
laughing, sneezing, or coughing.
Treatments for stress incontinence include Kegel exercises to strengthen the
muscles on the pelvic floor, biofeedback, medications, and surgery.
A new study compares two bladder-control surgeries that help support the
urethra, which is connected to the bladder. The two operations are:
The study included 655 women scheduled for urinary stress incontinence. The
researchers included Michael Albo, MD, of the University of California, San
Albo's team randomly assigned half of the women to get sling surgery and the
other half of the group to get Burch colposuspension.
For two years after the operations, the women periodically got checkups and
reported their symptoms and satisfaction with their surgical results.
Two years after surgery, sling surgery had a higher success rate for overall
urinary incontinence, with 47% of sling surgery patients reporting overall
success, compared with 38% of those who got Burch colposuspension.
The success rates specific to stress incontinence were even higher for sling
surgery, with 66% of sling surgery patients reporting success with stress
incontinence, compared with 49% of those who had gotten Burch
However, sling surgery's success came with a higher rate of side effects,
the researchers note.
After sling surgery, women were more likely to develop urinary tract
infections, to have problems emptying their bladders, and to have postsurgery
urge incontinence (overactive bladder), compared to women who got Burch
Success rates for both surgeries "declined steadily during the two-year
follow-up period," the researchers write.
Patients and doctors often define success differently, with patients having
higher standards for what's acceptable after urinary incontinence surgery
than doctors, note the researchers.
With that in mind, Albo's team set strict standards for surgery success,
including objective measures and patients' incontinence diaries.
"Only by comparing these surgical procedures in properly designed trials
can we offer patients clear, accurate, and honest recommendations about the
various treatment options," Albo says in a UCSD news release.
"Today, we have more treatments available than ever, options which
include tradeoffs between success and complications," Albo says. His
advice: "Patients and physicians should discuss these issues early on to
achieve individual goals."
Further studies are needed to "identify whether surgical procedures have
met patients' expectations and goals," states an editorial published with
the study in The New England Journal of Medicine.
Kris Strohbehn, MD, wrote the editorial. Strohbehn works in Lebanon, N.H.,
at Dartmouth Medical School's obstetrics and gynecology department and in the
division of urogynecology and reconstructive pelvic surgery at
Dartmouth-Hitchcock Medical Center.
SOURCES: Albo, M. The New England Journal of Medicine, May 24, 2007;
vol 356: pp 2143-2155. News release, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health. News release,
University of California, San Diego. Strohbehn, K. The New England Journal
of Medicine, May 24, 2007; vol 356: pp 2198-2200. News release, University
of Alabama at Birmingham.
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