Urinary Incontinence: Rating Surgeries

Sling Procedure May Trump Burch Colposuspension, but May Increase Side Effects

Medically Reviewed by Louise Chang, MD on May 22, 2007
From the WebMD Archives

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.

With that in mind, Albo's team set strict standards for surgery success, including objective measures and patients' incontinence diaries.

"Only by comparing these surgical procedures in properly designed trials can we offer patients clear, accurate, and honest recommendations about the various treatment options," Albo says in a UCSD news release.

"Today, we have more treatments available than ever, options which include tradeoffs between success and complications," Albo says. His advice: "Patients and physicians should discuss these issues early on to achieve individual goals."

Further studies are needed to "identify whether surgical procedures have met patients' expectations and goals," states an editorial published with the study in The New England Journal of Medicine.

Kris Strohbehn, MD, wrote the editorial. Strohbehn works in Lebanon, N.H., at Dartmouth Medical School's obstetrics and gynecology department and in the division of urogynecology and reconstructive pelvic surgery at Dartmouth-Hitchcock Medical Center.

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SOURCES: Albo, M. The New England Journal of Medicine, May 24, 2007; vol 356: pp 2143-2155. News release, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. News release, University of California, San Diego. Strohbehn, K. The New England Journal of Medicine, May 24, 2007; vol 356: pp 2198-2200. News release, University of Alabama at Birmingham.

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