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Sling Surgery Better Than Burch for Treating Stress Incontinence in Women

In the largest and most rigorous U.S. trial comparing two traditional operations for stress urinary incontinence (SUI) in women, a team of urologists and urogynecologists supported by the National Institutes of Health (NIH) has found that a sling procedure helps more women achieve dryness than the Burch technique.

"For the first time, we have a meticulous, relatively long-term comparison of these common surgeries in women," said Leroy M. Nyberg Jr., Ph.D., M.D., director of urology research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Women who participated in this study have made it possible for many women with stress incontinence and their doctors to make more-informed choices based on clear benefits, risks and personal preferences."

The Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) found that significantly more women with a sling made from the patient's own tissue and placed around the urethra for additional support were dry, compared to women with a Burch colposuspension, in which sutures are attached to a pelvic ligament to support the urethra. Both approaches are illustrated below. Two years after surgery, 47 percent of women who had the sling procedure and 38 percent who had a Burch were dry overall, including leakage that could have been caused by urge incontinence. Considering only stress-specific leakage, 66 percent of women with a sling and 49 percent with a Burch procedure were dry.

SISTEr randomized 655 women with either pure SUI or a combination of stress and urge incontinence to receive a fascial sling or a Burch. Complete information on measures used to assess urinary incontinence was available for 520 participants (79 percent) 24 months after surgery. Quality of life, patient satisfaction and side effects were also studied.

While most women in the study were satisfied with the results of treatment, those with a sling were significantly more
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