Study finds 2 sling surgeries equally effective for bladder control in women

Two common operations for stress urinary incontinence (SUI) help women achieve similar levels of dryness, according to a team of urologists and urogynecologists who compared the treatments in a large U.S. trial supported by the National Institutes of Health. The study is being released online May 17, 2010, by the New England Journal of Medicine to coincide with a presentation at the annual meeting of the American College of Obstetrics and Gynecology. Results will appear in the June 3 print edition.

The Trial of Mid-Urethral Slings found that the two most common mid-urethral sling procedures are similar in their chance of cure, though each surgery has different risks. Mid-urethral slings are a synthetic mesh material that acts as a hammock, or sling, to support the urethra and prevent leakage. The urethra is the tube through which urine passes out of the body.

One of the mid-urethral sling procedures tested by this study is transobturator, meaning through the obturator area of the pelvis. It passes the sling material under the urethra and out through the upper inner thigh or groin area. The other procedure is retropubic, or behind the pubic bones of the pelvis. It passes a sling material under the urethra and behind the pubic bone.

Twelve months after surgery, women who received the transobturator mid-urethral sling and women who received the retropubic mid-urethral sling had equivalent levels of treatment success: 78 to 81 percent of women achieved dryness. Considering only women's self-reported dryness, 62 percent in the retropubic group and 56 percent in the transobturator group reported they had been cured, a small difference between the two groups that could have occurred by chance.

"This rigorous, large-scale, comparative effectiveness trial represents a major milestone in treatment for stress urinary incontinence, an underdiagnosed public health problem affecting millions of American women," said Griffin P. Rodgers, M.D., director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the NIH. "Investments in this kind of research enable women and their doctors to weigh more accurately the benefits and risks of available treatment options."

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 study randomized 597 women with SUI to receive either a retropubic or transobturator mid-urethral sling. Complete information used to assess urinary incontinence was available for 95 percent of patients 12 months after surgery. Quality of life, patient satisfaction and side effects were also studied. Most women in the study were satisfied with the results of treatment.