satisfied. Eighty-six percent with a sling were satisfied, compared to 78 percent of the Burch group.
Side effects were more common among women with slings, tempering the positive results of the procedure. The most common side effect was urinary tract infections, which occurred in 63 percent of women with a sling and 47 percent of the Burch group. Women with a sling also had more voiding problems (14 percent versus 2 percent) and persistent urge incontinence, the loss of urine just before feeling a strong, sudden urge to empty the bladder (27 percent versus 20 percent). Nineteen women with slings who had difficulty voiding after treatment needed surgery to correct the problem; none in the Burch group needed corrective surgery for voiding problems.
Stress urinary incontinence, in which coughing, laughing, sneezing, running or lifting heavy objects causes urine to leak, is commonly treated with surgery designed to provide additional support to the bladder neck and urethra during increases in abdominal pressure that occur with these kinds of activities. However, randomized, controlled trials comparing these operations are rare. Studies predating SISTEr were small, short-term, or less stringent about diagnostic criteria and outcome measures, producing inconsistent results across studies. SISTEr set a higher bar by standardizing definitions, clinical evaluations, and surgical procedures at all sites and by using "composite outcome measures and a more rigid definition of success compared to other studies," according to the study.
SISTEr defined two levels of treatment success. Stress-specific success required that women have no symptoms of leakage during physical activities, no leakage during a valsalva and cough stress-test, and no re-treatment for the problem. Overall success required that women meet SUI-specific treatment goals, have a negative pad test and have no leakage episodes recorded on a three-day voiding diary.
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