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    Urinary Incontinence: Rating Surgeries

    Sling Procedure May Trump Burch Colposuspension, but May Increase Side Effects
    WebMD Health News
    Reviewed by 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 incontinence.

    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:

    • Sling surgery, which uses the patient's tissue to make a sling around the urethra
    • Burch colposuspension, in which doctors attach sutures to a pelvic ligament to support the urethra

    The study included 655 women scheduled for urinary stress incontinence. The researchers included Michael Albo, MD, of the University of California, San Diego (UCSD).

    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.

    Incontinence Surgery Results, Side Effects

    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 colposuspension.

    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 colposuspension.

    Success rates for both surgeries "declined steadily during the two-year follow-up period," the researchers write.

    What Is Success?

    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.

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