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Medical Care
Overactive Bladder (OAB) & Incontinence

The Debate About Surgery for Stress Urinary Incontinence

A Cochrane systematic review published in July 2015 makes an important contribution to an ongoing debate about surgery for stress urinary incontinence. The paper will help women make more informed choices about treatment, according to a release from the publisher. Inserting a “mid-urethral sling”, a type of tape, to support the muscles of the bladder by either the groin or abdomen results in similar cure rates. However, differences in complications and the long-term need for repeat surgery mean that women will need to balance a number of different factors when choosing an operation.

Stress urinary incontinence (SUI) is the involuntary loss of urine that occurs with coughing, sneezing or physical exertion. The word “stress” can be misleading since this type of involuntary urine loss has nothing to do with emotional stress. Also, another type of involuntary urine loss is called urge incontinence or  ” “overactive bladder” or “spastic bladder.” Sufferers, often women who have had children, experience a strong and sudden need to urinate with no warning. This condition is not helped by the mid-urethral sling. However, because stress incontinence happens due to weaknesses in the structures supporting the bladder and bladder outlet (urethra), the sling is useful.

Women whose symptoms persist despite trying non-surgical approaches such as pelvic floor exercises may be suitable candidates for surgery in order to improve bladder control. Surgery uses one of two common operations to insert a sling under the urethra in an effort to keep it supported. One approach is the insertion of a sling behind the pubic bone coming out via the abdomen (the bottom-to-top ‘retropubic’ route), or alternatively from side-to-side coming out through the groin (the ‘transobturator’ route).

The team of researchers included information from 81 trials in total, of which 55 made the direct comparison between the retropubic and transobturator routes. They found moderate quality evidence that at around 12 months, both routes had successfully cured symptoms in 80% of women. From the few studies that had reported 5-year data, rates of cure in both groups had fallen to around 70%.

Transobturator insertion seemed to carry a lower risk of bladder damage during the operation with around 6 women in 1000 experiencing this compared with 50 in 1000 in the retropubic groups, and fewer women (40 in 1000) in the transobturator group had persistent difficulty in being able to empty their bladder completely compared with around 70 in 1000 in the retropubic group.


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