Incontinence Surgeries Found to Vary
Success rates, side effects differ between leading procedures

(HealthDay News) -- Women who experience a type of urinary incontinence brought on by stress such as coughing, laughing, sneezing or heavy lifting should carefully examine the surgical options for treatment, experts say.

That's because researchers have found key differences in outcomes between the two most common corrective surgeries, called the Burch colposuspension and the fascial sling.

In a head-to-head study, "the sling was more effective in resolving urinary incontinence symptoms than the Burch, and it also showed significantly higher satisfaction rates," study co-author Dr. Michael E. Albo, an associate clinical professor of surgery at the University of California , San Diego , told HealthDay .

"The trade-off was that there were higher rates of complications with the sling," he said.

The findings, first presented at a meeting of the American Urological Association, were published in the New England Journal of Medicine .

Urinary incontinence affects twice as many women as men, says the National Kidney and Urological Diseases Information Clearinghouse, a difference attributed to pregnancy and childbirth, menopause and the structure of the female urinary tract.

Movements that put pressure on the bladder may cause "stress incontinence," a common and, in many cases, treatable type of involuntary urine leakage often brought about by physical changes resulting from pregnancy, childbirth and menopause, the clearinghouse explains.

Both the Burch procedure and the sling are designed to provide support to the bladder neck and urethra.

In the Burch procedure, a surgeon makes an incision in the abdomen and uses sutures to hold the bladder and urethra in a normal position, says the American Urogynecologic Society. Tissue around the urethra and near the bladder opening is stitched to the ligaments attached to the pubic bone.

With the sling, a piece of the woman's tissue is harvested and sutured around the urethra for additional support. Some doctors, though, prefer to use synthetic material or tissue from a cadaver donor, rather than the woman, to fashion the "sling" or hammock-like support.

The study found greater success with the sling. Two years after the procedures, 47 percent of sling patients were dry overall compared with 38 percent of the women who had the Burch procedure. For women with stress incontinence, 66 percent who had the sling procedure remained dry compared with 49 percent of the Burch group.

Asked how satisfied they were with the result of their surgery related to urine leakage, 86 percent of women who had sling surgery were satisfied compared with 78 percent of women who had the Burch procedure.

However, women with the sling procedure noted more side effects. These included urinary tract infections (63 percent of sling patients versus 47 percent of the Burch group); voiding problems (14 percent vs. 2 percent) and "persistent urge incontinence," the loss of urine just before feeling a strong, sudden urge to empty the bladder (27 percent vs. 20 percent).

What's more, 19 of the women with slings had difficulty voiding after treatment, requiring additional surgery to correct the problem, whereas none of those who underwent the Burch procedure needed follow-up surgery to rectify a voiding problem.

Stress incontinence surgery has implications for women's sex lives as well. Although there are not good data on which procedure is best for sexual function, typically "when incontinence improves, sexual function responds as well," co-author Dr. Linda Brubaker, a professor of obstetrics/gynecology and urology at Loyola University , told HealthDay .

The American Urological Association advises women to talk with a doctor about their symptoms and treatment options. Suggested questions include:

• Is my problem definitely stress incontinence, or could it be another type? If so, what are the treatment options?
• Which procedure do you recommend for my situation? What are the advantages and disadvantages?
• What are the risks of complications from surgery? What complications are most likely to occur? How will the complications be treated?
• How much will the surgery cost? How many days will I be in the hospital? How soon will I be able to resume normal activities?

On the Web

Learn more about urinary incontinence at the Web site of the National Kidney and Urologic Diseases Information Clearinghouse.

SOURCES: HealthDay News ; Michael E. Albo, M.D., associate clinical professor of surgery, University of California, San Diego, and co-director and founder, UCSD Healthcare Women's Pelvic Medicine Center, San Diego; Linda Brubaker, M.D., professor of obstetrics/gynecology and urology, Loyola University, Maywood, Ill.; May 24, 2007, New England Journal of Medicine ; May 21, 2007, news release, University of Pittsburgh; National Kidney and Urologic Diseases Information Clearinghouse, Bethesda, Md.; American Urogynecologic Society, Washington, D.C.; American Urological Association, Linthicum, Md.
Author: Karen Pallarito
Publication Date: May 31, 2008
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