SUI surgery more efficacious than physiotherapy

A recent study has shown that in women with moderate-to-severe stress urinary incontinence, surgery is more effective than physiotherapy.

Publishing their results in the New England Journal of Medicine (2013; 369:1124-33), the authors propose discussing the options of surgery as well as pelvic floor therapy with patients and then selecting the option that best suits the individual patient.

In the PORTRET study (Physiotherapy OR Tension free tape Randomized Efficacy Trial), 460 women aged 35 years and older suffering from moderate-to-severe SUI were equally divided between two groups. One group was given pelvic floor therapy by certified pelvic floor physiotherapists. Women in the other group underwent surgery by an experienced surgeon, who placed a midurethral sling below the urethra to support it.

One year later, the physicians checked whether these treatments had been effective. Subjective improvement was observed in 90.8% of the women who had had surgery, compared to 64.4% of the women who had started pelvic floor physiotherapy. (Of this group, 49% was also operated on within a year.) In the group who had undergone surgery, there were also more women who were completely cured (85.2%) than in the pelvic floor therapy group (53.4%).

About one in 10 women had mild complications (such as bruising or urge incontinence), which were entirely due to the surgery. While the complications did not have any permanent adverse effects, there were no such complications with pelvic floor therapy.

“Based on the outcomes of this study, we propose to adapt national and international guidelines. The current guidelines indicate that pelvic floor therapy is the mandatory standard initial treatment of stress incontinence in women. However, given that surgery has been found to be more effective, this option should be offered as primary therapy alongside pelvic floor therapy. If we properly explain the pros and cons of each of these treatment options, we can make the right choice together with the patient,” said co-author Huub van der Vaart, MD, PhD, of University Medical Center Utrecht, Utrecht, the Netherlands.

One study co-author has served on speakers bureaus for Ethicon, and one co-author has been a consultant to American Medical Systems.

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