Sebastian Ludwig1, Ingrid Becker2, Peter Mallmann3, Wolfram Jäger3. 1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany sebastian.ludwig@uk-koeln.de. 2. Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany. 3. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany.
Abstract
BACKGROUND: The aetiology of urgency urinary incontinence is a matter of debate. Current treatment options are based on the hypothesis of a neurological disorder of bladder innervation. However, it has also been hypothesised that one main cause is the reduced function of the bladder-holding apparatus, that is, insufficient suspension of the vesico-urethral junction. This study compared the effects of surgical apical vaginal elevation with those of solifenacin on urgency urinary incontinence in women. PATIENTS AND METHODS: Women with mixed and urgency urinary incontinence were randomised to either an established pharmacological arm (10 mg/day solifenacin) or the surgical arm (bilateral uterosacral ligament replacement, cervicosacropexy, CESA; or vaginosacropexy, VASA. Clinical and objective outcomes were assessed at 4 months after each type of intervention. RESULTS: The study was terminated early; 55 patients were operated on and 41 patients receivedpharmacological treatment. After surgical treatment, 23 patients (42%, 95% confidence intervaI=29-55%) became continent compared to four patients (10%, 95% confidence intervaI=1-19%) during solifenacin treatment. CONCLUSION: Compared to pharmacological treatment, the surgical repair of the apical vaginal end restored urinary continence in significantly more patients. Copyright
RCT Entities:
BACKGROUND: The aetiology of urgency urinary incontinence is a matter of debate. Current treatment options are based on the hypothesis of a neurological disorder of bladder innervation. However, it has also been hypothesised that one main cause is the reduced function of the bladder-holding apparatus, that is, insufficient suspension of the vesico-urethral junction. This study compared the effects of surgical apical vaginal elevation with those of solifenacin on urgency urinary incontinence in women. PATIENTS AND METHODS: Women with mixed and urgency urinary incontinence were randomised to either an established pharmacological arm (10 mg/day solifenacin) or the surgical arm (bilateral uterosacral ligament replacement, cervicosacropexy, CESA; or vaginosacropexy, VASA. Clinical and objective outcomes were assessed at 4 months after each type of intervention. RESULTS: The study was terminated early; 55 patients were operated on and 41 patients received pharmacological treatment. After surgical treatment, 23 patients (42%, 95% confidence intervaI=29-55%) became continent compared to four patients (10%, 95% confidence intervaI=1-19%) during solifenacin treatment. CONCLUSION: Compared to pharmacological treatment, the surgical repair of the apical vaginal end restored urinary continence in significantly more patients. Copyright
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Daniel J Caruso; Prashanth Kanagarajah; Brian L Cohen; Rajinikanth Ayyathurai; Christopher Gomez; Angelo E Gousse Journal: Int Urogynecol J Date: 2010-06-18 Impact factor: 2.894