Loyola urogynecologist: Both procedures offer relief with a few trade-offs
(MAYWOOD, Ill.) May 21, 2007 - A study that compared two traditional surgical procedures for treating stress incontinence in women has found that a fascial sling, crafted of a woman's own pelvic muscle, produces greater patient satisfaction than Burch colposuspension, a method that repositions the bladder and urethra by suspending the vaginal wall.
"Both traditional procedures have been widely used. But in this study we saw that, over time, patients are generally more satisfied with the results of the sling procedure," explains Dr. Linda Brubaker, professor, Obstetrics & Gynecology and Urogynecology, Loyola University Chicago Stritch School of Medicine,a principal investigator in the nationwide NIH trial known as SISTEr, for Stress Incontinence Surgical Treatment Efficacy Trial. The study is being released early by the New England Journal of Medicine (NEJM) to coincide with a presentation at the annual meeting of the American Urological Association. Results will appear in the May 24 print edition of NEJM.
A total of 655 study participants were randomly assigned to either undergo the sling procedure of the Burch colposuspension to treat their urinary stress incontinence. Stress incontinence affects 20 percent of women age 75 or older and occurs when urine leaks while coughing, sneezing, laughing. Risk factors for stress incontinence include being female, aging, childbirth, smoking, obesity or chronic coughing.
In the 520 women who completed their evaluation 24 months post-procedure, the sling group showed a higher success rate than the Burch procedure (47 percent vs. 38 percent for Burch); a higher stress-specific success rate with 66 percent for sling and 49 percent for Burch; and a significantly higher patient satisfaction rate (86 percent, vs. a 78 percent satisfaction rate for Burch).
However, even with higher success rate of the sling, researchers noted that there were some trade-offs accompanying these procedures. Sling recipients reported more urinary tract infections, 48 percent vs. 32 percent with Burch. Sling patients also were more likely to report difficulty urinating (14 percent vs. 2 percent) and more often complained of persistent urge incontinence (27 percent vs. 20 percent) than the Burch group. Urge incontinence is a strong, sudden need to urinate and differs from stress incontinence. Women in the Burch group were more likely to have a second surgery for treatment of stress incontinence, according to the study's findings.
"When making treatment decisions for our patients with urinary incontinence, we look at what is important to the patient. There is a role for both procedures. It all depends on what you call a 'cure' and if you're willing to live with certain trade-offs," explains Brubaker.
She points out that new techniques and minimally invasive options for urinary incontinence are currently being studied, including the popular mid-urethral sling made of a mesh fabric.
Still, some women opt for non-surgical therapies, explains Brubaker who established the Loyola Urogynecology and Reconstructive Pelvic Surgery Center. "Every woman should have individual counseling so that she can be aware of her treatment options. What is best for one woman may not be the right choice for another."