Surgery Better Than Muscle Training for Urinary Incontinence

A new study shows that women with stress urinary incontinence (SUI) had better subjective improvement and higher cure rates when treated initially with surgery instead of pelvic floor-muscle training.

Researchers at University Medical Center Utrecht (The Netherlands) and 23 other participating centers conducted a multicenter, randomized trial to compare physiotherapy involving pelvic-floor muscle training—advocated as first-line treatment for SUI—and midurethral-sling surgery (generally recommended when physiotherapy is unsuccessful). In all, 230 women were assigned to each group, and crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement (PGII) at 12 months.

The results showed that PGII improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group, while rates of objective cure were 76.5% and 58.8%, respectively. In all, 49% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. Women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery, and both these groups had outcomes superior to those of women who did not cross over to surgery. The study was published online on September 18, 2013, in the New England Journal of Medicine (NEJM).

“Our findings suggest that women with [SUI] should be counseled regarding both pelvic floor-muscle training and midurethral-sling surgery as initial treatment options,” concluded lead author Julien Labrie, MD, and colleagues. “Information on expected outcomes with both interventions, as well as on the potential, albeit infrequent, complications of surgery, will allow for individualized decision making by each women and her healthcare provider.”

There are various surgical options for women with SUI who have not responded to physiotherapy or medications. The mid-urethral sling is a piece of surgical tape that supports the middle section of the urethra, and is intended for women with SUI whose muscles and nerves in this area are no longer working properly. The procedure is sometimes performed in combination with other procedures, such as vaginal repair.

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University Medical Center Utrecht