Minimally Invasive Operations Effective for Stress Urinary Incontinence

New, less invasive surgical treatments for stress urinary incontinence (SUI) in women are just as effective as traditional open surgical approaches, according to a new review of studies.

Researchers at the Leeds University Teaching Hospital (United Kingdom) collected data from 62 trials involving 7,101 women to assess the effects of minimally invasive synthetic suburethral sling operations for treatment of SUI, urodynamic stress incontinence (USI), or mixed urinary incontinence (MUI) in women. The researchers selected randomized or quasi-randomized controlled trials in which at least one trial arm involved a minimally invasive synthetic suburethral sling operations.

The researchers found that minimally invasive synthetic suburethral sling operations were just as effective as traditional sling operations, with short-term cure rates of 80%; they also had shorter operating times than conventional methods. Minimally invasive sling operations were also more effective than a second type of open surgery, open retropubic colposuspension, in which the vagina is lifted using stitches to help support the bladder and urethra. However, when this second type of surgery was carried out using laparoscopic procedures, there was less evidence that minimally invasive sling operations worked better. Different methods of inserting the tape in sling operations were also compared, and those in which the tape was passed behind the pubic bone appeared to be most effective, although this approach was more likely to cause bladder injury. One particular type of sling material, type I mesh, was more effective and appeared to result in fewer complications. The study was published in the October 7, 2009, issue of the Cochrane Database of Systemic Reviews.

"These were only small trials and they varied greatly in quality, but we were able to make comparisons between different types of surgery and we found that minimally invasive sling operations for stress incontinence in women are very effective for this condition,” said lead researcher, Joseph Ogah, M.A. "However, few of the trials we looked at reported outcomes after one year and therefore the long term efficacy of these procedures requires further investigation. It is also of utmost importance to assess how these procedures impact on women's quality of life, so this needs to be addressed in further studies.”

A third of all women suffer from SUI; as well as the social distress involved, the condition places a significant financial burden on health systems and individuals. Surgery is considered a last resort when other treatments, such as pelvic floor muscle training and drug therapies, fail. In sling operations, strips of mesh are positioned under the urethra and traditionally are anchored to muscles and ligaments to form a sling. When the woman strains the sling tightens and supports the bladder. In newer minimally invasive sling operations, a synthetic material is inserted underneath the urethra without fixing to muscles or ligaments.

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Leeds University Teaching Hospital