A Comparison of Vaginal and Suprapubic Surgery in the Correction of Incontinence due to Urethral Sphincter Incompetence

Abstract

A preliminary comparison is presented, with pre-operative and post-operative objective assessment, of 25 women undergoing anterior repair and 25 women undergoing colposuspension for the correction of incontinence due to urethral sphincter incompetence. Colposuspension was found to be effective. The mechanism of successful cure was likely to be a combination of bladder neck and proximal urethral elevation and narrowing.

Comparative Analysis of Bladder Neck Suspension Using Raz, Burch and Transvaginal Burch Procedures

“…Comparing results of different authors [13, 14, 15, 16, 17, 18, 19], we did not find any significant difference between the transvaginal needle suspension and the retropubic urethropexy in the treatment of female SUI.…”

“…Numerous clinical studies comparing retrospectively [13, 14, 15, 16] or prospectively [17, 18, 19] results of two or more different surgical procedures for SUI have demonstrated that long-term results of the abdominal procedure are better than those of the vaginal procedure. At the very beginning of our study, we intentionally chose very strict criteria for the evaluation of surgical results.…”

The 75% rule: all stress incontinence procedures are alike

“…This statement was probably true at that time but was a result of a lack of good comparative trials rather than a similar effectiveness of all stress incontinence procedures. This was subsequently shown to be the case when good prospective randomized studies were reported [1,2]. Thirty years on we are making the same mistake, using untried surgeries and assuming equivalence without evidence.…”

My mentors in urogynecology

“…Stuart was the first to carry out an RCT comparing anterior vaginal colporrhaphy and Burch colposuspension [1]. His studies established the place of the Burch colposuspension as the gold standard during the 1980s and 1990s [1]. Before this, most stress incontinence studies were retrospective reviews of personal, operator-assessed series, unsurprisingly reporting very high success rates.…”

“…Many were prospective randomized comparisons using objective measures to assess procedures in stress urinary incontinence and prolapse; a rarity in any surgical disciple in the 1970s and 1980s. Stuart was the first to carry out an RCT comparing anterior vaginal colporrhaphy and Burch colposuspension [1]. His studies established the place of the Burch colposuspension as the gold standard during the 1980s and 1990s [1].…”