Surgery May Avoid Urinary Incontinence

Procedure Used for Women Getting Surgery for Pelvic Prolapse

Medically Reviewed by Louise Chang, MD on April 12, 2006
From the WebMD Archives

April 12, 2006 -- For women with pelvic-organ prolapse, getting two operations at the same time may help avoid new cases of stress incontinence.

In pelvic-organ prolapse, the pelvic muscles and connective tissue are weak or injured. As a result, the patient's bladder, bowel, and uterus press down on (and possibly bulge through) the vagina.

The condition is common, and surgery can correct it. Although urinary stress incontinence can coincide with pelvic-organ prolapse, it may also develop for other reasons and can happen after surgical repair of the prolapse. People with stress incontinence have leaking of urine while coughing, laughing, sneezing, exercising, lifting, or bending over.

If stress urinary incontinence develops, a second surgery -- called a Burch colposuspension -- can be done. Doing both operations at once might be better than taking the wait-and-see approach, doctors report in The New England Journal of Medicine.

'Important Advance'

The study was funded by the National Institute of Child Health and Human Development (NICHD), a branch of the National Institutes of Health.

The new study is "an important advance in treatment for a large number of women," NICHD Director Duane Alexander, MD, says in a news release.

Each year, more than 200,000 women have prolapse surgery, Alexander notes. "These research findings could prevent incontinence in many of them," he says.

The researchers who conducted the study included Linda Brubaker, MD. She works in the obstetrics and gynecology department of Loyola University Medical Center in Maywood, Ill.

Brubaker's team studied 322 women scheduled for prolapse surgery. None of the women had stress urinary incontinence before prolapse surgery.

All of the women got a type of prolapse surgery called abdominal sacrocolpopexy. In addition, 157 women also got Burch colposuspension.

Study's Results

Before and after surgery, the women were interviewed by phone about incontinence and quality of life.

Three months after surgery, nearly 24% of the women who had gotten both surgeries had stress urinary incontinence. So did 44% of those who had only gotten prolapse surgery. Women who only got prolapse surgery were also more likely to report "bothersome" stress incontinence, the study states.

Burch colposuspension can lead to other urinary problems, including urge incontinence (overactive bladder), in which urine leaks are linked to the sudden need to urinate.

In Brubaker's study, both groups had similar rates of postoperative urge incontinence (about 33% of patients who got both surgeries and 38% of those who only had prolapse surgery).

Longer Studies Needed

Doing the two surgeries at the same time "markedly reduces the risk of postoperative stress incontinence without increasing the risk of adverse urinary symptoms, such as urge incontinence," the researchers write.

Brubaker's team followed up with 231 women a year after surgery. At that point, 24% of the women who had gotten both operations had stress urinary incontinence, compared with 46% of those who had only gotten prolapse surgery.

But Brubaker's study wasn't meant to be a lengthy project. Longer studies are needed and the findings don't necessarily apply to other women, write Brubaker and colleagues. A journal editorial agrees.

Brubaker's findings are "important," writes editorialist Rebecca Rogers, MD. She notes that the study "raises the bar for the evaluation of future surgical innovations."

Rogers works in the obstetrics and gynecology department at the University of New Mexico Health Sciences Center in Albuquerque, N.M.

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SOURCES: Brubaker, L. The New England Journal of Medicine, April 13, 2006; vol 354: pp 1557-1566. WebMD Newly Diagnosed: "Overactive Bladder/Urge Incontinence: What Is It?" Rogers, R. The New England Journal of Medicine, April 13, 2006; vol 354: pp 1627-1629. News release, National Institute of Child Health and Human Development, National Institutes of Health.
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