Köln, Germany—Bilateral replacement of the uterosacral ligaments with a polyvinylidene fluoride (PVDF) mesh (DynaMesh, FEG Textiltechnik mbH) is more effective than medical treatment with solifenacin (Vesicare) for achieving continence in women with urgency urinary incontinence (UUI) associated with only minor pelvic organ prolapse, according to the interim results of a prospective, randomized, crossover clinical trial.
Findings from the URGE 1 study were presented at the AUA annual meeting in San Diego.
“The results of our study refute the idea that UUI cannot be cured by surgical intervention unless a patient has more advanced prolapse, and they are consistent with the hypothesis that UUI is caused by defective uterosacral ligaments,” said first author Sebastian Ludwig, MD, a urogynecologist at University Hospital of Cologne, Köln, Germany.
The idea for performing uterosacral ligament augmentation to treat UUI in women with POP-Q stage I was based on a published report showing that suturing of the vaginal cuff to the uterosacral ligament combined with a pubovaginal sling cured UUI in 82% of women who were POP-Q stage II-IV (J Urol 2003; 169:1770-4).
“Most women with UUI, however, are POP-Q stage I,” Dr. Ludwig said.
Dr. Ludwig and senior author Wolfram Jäger, MD, professor of urogynecology at University Hospital of Cologne, presented data from a total of 77 women with UUI who were randomized to treatment with solifenacin, 10 mg daily (n=37), or to surgical intervention (n=40). The surgery is an open abdominal procedure in which the PVDF tapes are fixed to the sacral bones and at either the cervix when the uterus is intact (cervico-sacropexy) or the vagina (vagino-sacropexy) using non-absorbable sutures (Gynecol Obstet Invest 2012; 74:157-64) (www.cesa-vasa.com).
The study had a crossover design such that women who did not achieve continence after 4 months of medical therapy or 4 months after surgery were offered the alternate therapy.