Table 26.7

Table 26.7—Efficacy of Surgical Treatments for Stress Incontinence

Treatment	Target Population	Efficacy	Evidence*
Retropubic suspension	Women	Short term cure 69%-88%, 5 years 70%; cure or improvement 84%;** complications 18% (range 6%–57%)	A–B
Needle suspension	Women	More likely to fail than open suspension (29% failed vs 16%, RR 2.00 [95% CI, 1.47 to 2.72]), with no differences in complications (23% vs 16%) if first UI surgery. May be as effective as anterior vaginal repair (36% failed vs 39%, RR 0.93 [0.68 to 1.26]). Limited data comparing with suburethral slings.	A
Anterior vaginal repair (colporrhaphy)	Women	Less effective than open suspension (year 1 failure rate 29% vs 14%; long-term 41% vs 17%), with more repeat operations (23% vs 2%, RR 8.87 [95% CI, 3.28 to 23.9])	A–B
Vaginal sling	Women with stress UI, ISD, hypermobility	Short term-cure rates with TVT similar to open abdominal retropubic suspension; complications 9%. Gore-Tex slings may have higher complications than rectus fascia slings. Limited long-term results	B–C
Marshall-Marchetti-Krantz (open suspension)	Women	Scant data in older or frail women; in younger women up to 88% success rate	C
Periurethral bulking injections	Women with ISD	Cure 50% (range 8%–100%), cure or improvement 67%	B
	Men with ISD	Cure 20% (range 0%–66%), cure or improvement 42%	B
Artificial sphincter	Women with ISD	Cure 77%, cure or improvement 80%; revision rate 40%–50%; less data than with men	B
	Men with ISD	Cure 66% (range 33%–88%), cure or improvement 85% (range 75%–95%); revision rate 40%–50%	B

* Evidence strength: A = randomized controlled studies; B = case-control studies; C = case descriptions or expert opinion.

** Subjective cure may be less because of persistent or de novo urge incontinence or voiding difficulty.

NOTE: CI = confidence interval; ISD = intrinsic sphincter deficiency; RR = relative risk; TVT = tension-free vaginal tape; UI = urinary incontinence.

SOURCES: Data from Fantl JA, Newman DK, Colling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline No. 2, 1996 Update. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; March 1996. AHCPR Pub. No. 96-0682; Abrams P, Cardozo L, Khoury S, et al., eds. 2nd International Consultation on Incontinence. Plymouth, UK: Health Publication Ltd; 2002; Cochrane Library (accessed July 2003).