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News

Surgery vs physiotherapy for stress urinary incontinence

This week's publication of the New England Journal of Medicine compares surgery with physiotherapy for stress urinary incontinence.

News image

Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence.

Midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful.

Data are lacking from randomized trials comparing these 2 options as initial therapy.

Dr Julien Labrie and colleagues performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence.

Crossover between groups was allowed.

Rates of subjective cure were 85% in the surgery group
New England Journal of Medicine

The researcher's primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months.

The team randomly assigned 230 women to the surgery group, and 230 women to the physiotherapy group.

A total of 49% of women in the physiotherapy group, and 11% of women in the surgery group crossed over to the alternative treatment.

In an intention-to-treat analysis, subjective improvement was reported by 91% of women in the surgery group, and 64% of women in the physiotherapy group.

The research team found that the rates of subjective cure were 85% in the surgery group, and 53% in the physiotherapy group.

Rates of objective cure were 76% and 59%, respectively.

The team showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery, and that both these groups had outcomes superior to those of women who did not cross over to surgery.

Dr Labrie's team concludes, "For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year."

N Engl J Med 2013; 369: 1124-1133
26 September 2013

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