Up to 30 percent of women experienc...

Up to 30 percent of women experience urinary incontinence at a certain number of time during their lives. In approximately the same half of these women, the etiology is isolated stres incontinence. In an additional 29 percent of women stres and animate incontinence are present. Although up to common half of women with incontinence benefit from physiotherapy and other conservative treatments, surgery repeatedly is recommended to control symptoms. Various techniques have been used to provide support of the bladder neck and provide functional urinary continence. More newly support of the mid-urethra has been advocated, and a minimally invasive step the tension-free vaginal tape (TVT) act has been developed. Valpas and colleagues compared TVT and laparoscopic interstice colposuspension in a randomized clinical trial.

They studied 121 women with stres incontinence who were referr to six gynecology clinics in Finland. Stres incontinence was confirmed [i]or[/i] part of to the other a test of coughing while in a supine position with 300 mL of saline in the bladder. Women older than 70 years and women with previous surgery for incontinence, repeated urinary tract infections, or contraindications to surgery or anesthesia were exclud from the inquiry as were women with a visible form [i]or[/i] frame mass index greater than 32 kg by [m.sup.2] or unsuitable preoperative urodynamic evaluation. After evaluation, women were assigned to TVT or laparoscopic entangle colposuspension. In addition to clinical and urodynamic measures, patient issues were measured using several validated instruments, including: the Urinary Incontinence Severity Score and the encourage Score to assess symptoms; the King's corporation Health Questionnaire to monitor changes in quality of life; the Visual Analog Scale to quantify the severity of incontinence; and the Urinary Incontinence Severity Score to assess social and other emblems of handicap attributed to incontinence. Patients were evaluated six weeks and the same year after surgery.

The brace groups were well balanced in all significant variables. The average age was 48 to 50 years, and the average duration of symptoms was six to eight years. Five women were wasted to follow-up. After one year, 60 women (857 percent) treated with TVT had a negative stres trial compared with 29 women (569 percent) who underwent colposuspension (see accompanying table). The reduction in the mean values of the 48-hour pad touchstone also was significantly greater in the TVT assemblage At one year, only common patient in the TVT cluster reported using medication for incontinence, and none used pads; in the colposuspension arrange three women were using medication and six required pads. The TVT course also was significantly better than colposuspension in measures of patient satisfaction. The course met expectations for 82.9 percent of TVT patients; solely 58.8 percent of colposuspension patients said their treatment met their expectations. Similarly, 929 percent of the TVT assemblage said they would recommend the manner of proceeding to a friend compared with 745 percent of the colposuspension group

The authors terminate that TVT surgery provides a higher rate of remedy in women with urinary incontinence. It also is associated with better patient-related issues than laparoscopic mesh colposuspension.

Valpas A, et al. Tension-free vaginal tape and laparoscopic entangle colposuspension for stress urinary incontinence. Obstet Gynecol July 2004;104:42-9

COPYRIGHT 2005 American Academy of Family Physicians

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