Sling better than colposuspension for stress urinary incontinence

A large study by a team of urologists and urogynecologists has found that in a comparison of the two traditional surgical operations for stress urinary incontinence (SUI) in women, using an internal sling to support the uretha was more effective than colposuspension.

Urinary incontinence is a common and costly condition that affects the quality of life for many women.

Stress urinary incontinence, in which coughing, laughing, sneezing, running or lifting heavy objects causes urine to leak, is commonly treated with surgery designed to provide additional support to the bladder neck and urethra during increases in abdominal pressure that occur with these kinds of activities.

Both techniques aim to reduce urinary stress incontinence by lifting the urethra into the normal position after it has dropped down with age.

The researchers found that women appeared to be happier with a procedure that uses a sling of tendon, muscle or other material to hold the urine tube than another technique that anchors the tube to ligament for preventing urine leakage.

However one drawback seems to be that the sling method appears to produce more long-term side effects; it made women more prone to urinary tract infections, the women sometimes found it harder to urinate, and they were more likely to suffer from the sudden need to urinate.

Although the sling was more effective in fixing a certain type of incontinence in women no procedure worked perfectly.

The problem of stress incontinence in women is not uncommon and up to 10 percent of U.S. women have some kind of surgery to prevent leakage, particularly when they cough, sneeze or strain, and as many as 40 percent of older woman have some degree of incontinence.

The study monitored women for two years after surgery, which was considered successful by asking whether a woman reported leaking or whether she leaked while coughing.

Dr. Michael Albo of the University of California San Diego and his colleagues say the technique using ligament, muscle or tendon to create a sling for the urethra worked in 66 percent of the 326 women, compared to a 49 percent success rate for the 329 women treated with the anchoring technique, also known as Burch colposuspension.

While most women in the study were satisfied with the results of treatment, those with a sling were significantly more satisfied; 86 percent with a sling were satisfied, compared to 78 percent of the Burch group.

The team say doctors should discuss the pro's and con's with their patients and "emphasize that complete resolution of incontinence symptoms after surgery is unlikely."

Other studies have reported the success rate for both procedures to range from 70 to 90 percent.

The study was supported by the National Institutes of Health (NIH) and is published in the current issue of the New England Journal of Medicine.

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