Prophylactic Midurethral Sling Reduces Urinary Incontinence
Midurethral sling placement in vaginal prolapse surgery cuts incontinence, ups adverse events
WEDNESDAY, June 20 (HealthDay News) -- For women without preoperative stress incontinence, placement of a midurethral sling at the time of vaginal prolapse surgery correlates with reduced rates of urinary incontinence at three and 12 months as well as increased rates of adverse events, according to a study published in the June 21 issue of the New England Journal of Medicine.
John T. Wei, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a multicenter trial involving 337 women without symptoms of stress incontinence and with anterior prolapse who were planning to undergo vaginal prolapse surgery. The participants were randomized to receive a midurethral sling or sham incisions during the surgical procedure; 327 (97 percent) completed follow-up at one year.
At three months the researchers found that the rate of urinary incontinence (or treatment) was 23.6 and 49.4 percent in the sling and sham groups, respectively (P < 0.001). Allowing for subsequent treatment of incontinence, at 12 months, incontinence was seen in 27.3 and 43.0 percent of the sling and sham groups, respectively (P = 0.002). To prevent one case of incontinence at 12 months, the number needed to treat with a sling was 6.3. In the sling group there was a significantly increased rate of complications, including bladder perforation, urinary tract infection, major bleeding complications, and incomplete bladder emptying at six weeks after surgery.
"Counseling of women who are planning to undergo vaginal-prolapse surgery should include attention to both the benefits and the risks of sling placement," the authors write.
Several authors disclosed financial ties to the pharmaceutical and surgical device industries.