Two Operations for Urinary Incontinence Offer Similar Results

Women with SUI leak urine with coughing, laughing, sneezing, running or lifting heavy objects. SUI is commonly treated with surgery designed to provide additional support to the bladder neck and urethra during increases in abdominal pressure that occur with activities. Mid-urethral sling surgeries are approved by the FDA and have been performed in the United States for more than a decade.

The two procedures utilize mid-urethral slings, which are composed of a synthetic mesh material that acts as a hammock to support the urethra and prevent leakage.The first of the two procedures compared in the study is transobturator, or through the obturator area of the pelvis. The mid-urethral sling passes under the urethra and out through the inner thigh or groin area. The other procedure is retropubic, meaning behind the pubic bones of the pelvis. The sling material is passed under the urethra and behind the pubic bone.

The study randomized nearly 600 women with SUI to receive either a transobturator or retropubic mid-urethral sling. Quality of life, patient satisfaction, and side effects were also studied. Most women in the study were reportedly satisfied with the treatment results.

A year following surgery, women who had undergone the transobturator sling procedure and women who received the retropubic mid-urethral sling had equivalent levels of treatment success: 78 to 81 percent of women achieved dryness.

The study defined two types of treatment success. The surgery was deemed an objective success if participants had no leakage during a stress test and a 24-hour pad test, and they had no additional treatment for the problem. Women also reported leakage using validated questionnaires and a three-day voiding diary, and reported any additional treatment with surgery, behavioral therapy, or drug therapy. If women reported a negative result on these measures, then the surgery was considered a subjective success.

Urinary incontinence is a common and costly condition that results in poorer quality of life for American women. Other studies have found that approximately half of women have some degree of urinary incontinence, and the direct cost of incontinence for women was $12.4 billion in 1995, the last year for which national estimates are available.