Two Urinary Incontinence Treatments Equally Effective

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Two surgical treatments for stress urinary incontinence appear to be nearly equally effective in relieving symptoms of this common condition, according to researchers at UT Southwestern Medical Center. One year after the two incontinence procedures were performed, women in both treatment groups reported similar success.

Up to 50 percent of women in the United States experience stress incontinence during their lifetime. In women, stress incontinence occurs when the bladder’s sphincter muscle is weakened, typically by pregnancy, childbirth, and menopause. The condition involves leakage during increased abdominal pressure triggered by sneezing, lifting heavy objects, laughing, coughing, or other physical activities. Nonsurgical treatments include exercises that strengthen the pelvic floor muscles, such as Kegel exercises.

For the new study, UT Southwestern surgeons and colleagues at eight other sites conducted a comparison of transvaginal sling (TVT) and transobturator midurethral sling (TOT), two common surgical procedures performed to alleviate symptoms of stress urinary incontinence.

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The older of the two techniques, TVT sling, involves placing a polyprophylene mesh weave strip transvaginally behind the urethra and pubic bone to support the urethra. With the TOT sling, surgeons place the sling laterally into the groin through two incisions in the upper thigh. While both techniques support the urethra, there has been debate about which sling is more effective and which may pose more complications.

Investigators from all the sites evaluated outcomes of the surgeries after one year in 565 women. Gary Lemack, professor of urology and neurology and co-principal investigator at the UT Southwestern site, noted that “The outcomes appear very similar at one year regardless of the severity of the patient’s stress incontinence symptoms.”

Overall, success rates were about 81 percent for the TVT sling and 78 percent for the TOT sling. Although subjective success rates were slightly higher in the TVT group, the difference was not significant. Both procedures were associated with risks: women who underwent TVT were more likely to experience intraoperative bladder injury and postsurgical voiding problems, while those in the TOT group were more likely to have postoperative numbness and pain.

Lemack explained that their findings add to the information physicians can share with patients who are contemplating surgery for their urinary incontinence. Women who want more information about urinary incontinence can visit the US Department of Health and Human Services website on the topic.

SOURCES:
Mayo Clinic
Richter HE et al. New England Journal of Medicine 2010 May 17

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