Female Urinary Incontinence Surgeries Go Head-to-Head

Trial finds 'sling' procedure gives better results, but has higher complication rate

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By
HealthDay Reporter

MONDAY, May 21, 2007 (HealthDay News) -- The results of a new head-to-head trial could help women with stress urinary incontinence decide between two surgeries -- called the Burch and the sling -- that are commonly used to correct the condition.

According to the study, "The sling was more effective in resolving urinary incontinence symptoms than the Burch, and it also showed significantly higher satisfaction rates," said study co-author Dr. Michael E. Albo, an associate professor of surgery at the University of California, San Diego. "The trade-off was that there were higher rates of complications with the sling."

The findings were presented Monday at the American Urological Association's annual meeting in Anaheim, Calif. They will also be published in the May 24 issue of The New England Journal of Medicine.

Doctors already have good evidence as to the benefits and risks of both of these procedures, Albo said, since more than 100,000 operations for urinary incontinence are performed in the United States each year. Based on that history, "we can now counsel our patients about what to expect from these procedures," he said.

The Burch and sling procedures are aimed at correcting "stress urinary incontinence" -- leakage that can result from coughing, laughing, sneezing, running or lifting heavy objects. Both of the surgeries are designed to provide support to the bladder neck and urethra during increases in abdominal pressure that happen with these kinds of activities.

In the sling procedure, a sling made from the patient's own tissue is placed around the urethra for additional support. With the Burch method, sutures are attached to a pelvic ligament to support the urethra. Both procedures require an abdominal incision and an overnight hospital stay.

In the study, 655 women with stress urinary incontinence received either the sling procedure or the Burch.

The researchers found that two years after the procedures, 47 percent of the women who had the sling were dry overall compared with 38 percent on the women who had the Burch. For women who suffered stress incontinence, 66 percent who had the sling procedure remained dry compared with 49 percent who had the Burch.

Most women in the study said they were satisfied with the results of their treatment, whichever surgery they had received. However, 86 percent women with the sling surgery were satisfied compared with 78 percent of women who had the Burch.

On the other hand, there were more side effects noted among women who received the sling, the researchers found. The most common were urinary tract infections, which affected 63 percent of women with a sling and 47 percent of women with a Burch. The sling also had more voiding problems associated with it (14 percent vs. 2 percent) and "persistent urge incontinence" -- the loss of urine just before feeling a strong, sudden urge to empty the bladder (27 percent vs. 20 percent).

Moreover, 19 women with slings had difficulty voiding after treatment, requiring additional surgery to correct the problem. None of the women who underwent the Burch needed corrective surgery for voiding problems.

There are also new procedures that are variations on the sling, Albo noted. In these procedures a synthetic mesh is used to secure the urethra into position. The advantages of these new techniques are that they require a smaller incision, and usually the patient can go home the same day as the procedure is done. For doctors, the mesh is easier to place than making a sling from the patients own flesh, he said.

Albo said studies are under way comparing these newer procedures to both the standard Burch and sling.

"We are in the middle of trials looking at new procedures," added co-author Dr. Linda Brubaker, a professor of obstetrics/gynecology and urology at Loyola University. "These newer procedures are becoming more common," she said.

Another issue surrounding these procedures is sexual function. While data on which procedure is best in terms of sexual function has not been released, Brubaker said that, typically, "When incontinence improves, sexual function responds as well."

Incontinence is more than just an annoyance, she added. "Incontinence is not painful or life-threatening," Brubaker said. "But, it dramatically decreases the quality of life for women," she said.

One expert believes the study will help doctors and patients in choosing which procedure is best for them.

"Incontinence is fixable," said Dr. John Lavelle, the director of urophysiology at the University of North Carolina. "At least half the patients will be symptom-free after treatment," he said.

Based on this study, patients will most likely opt for the sling, Lavelle said. "There is no answer about whether the mesh sling is better or worse than the tissue sling, although more women seem to be opting for the mesh sling," he said.

Lavelle agreed that treating incontinence can improve sexual function. "A lot of women will tend not to have intercourse with their partner, because they are afraid of being wet," he said. "So, when they are fixed and they are dry, they probably resume sexual activity," he added.

In another presentation scheduled for the same meeting, researchers at the University of Pittsburgh School of Medicine used stem cells to treat women with stress urinary incontinence. The procedure strengthened patients' sphincter muscles, providing them with long-term improvement.

Of the eight women in the trial, five reported improvement in bladder control and quality of life with no serious short- or long-term adverse effects one year after treatment.

"This clinical trial is extremely encouraging, given that 13 million people in the United States, most of them women, cope with stress urinary incontinence," lead researcher Dr. Michael B. Chancellor, a professor of urology and gynecology, said in a prepared statement. "We're demonstrating for the first time that we may be able to offer people with stress urinary incontinence a long-term and minimally invasive treatment option."

More information

Learn more about urinary incontinence at the American Academy of Family Physicians.

SOURCES: Michael E. Albo, M.D., associate professor, surgery, University of California, San Diego; Linda Brubaker, M.D., professor, obstetrics/gynecology and urology, Loyola University, Maywood, Ill.; John Lavelle, M.B., director, urophysiology, University of North Carolina, Chapel Hill; May 24, 2007, The New England Journal of Medicine; May 21, 2007, news release, University of Pittsburgh

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