What Criteria Should Urologists Use When Choosing Surgery for Stress Urinary Incontinence?

摘要

The gold standard treatments for stress urinary incontinence (SUI) remain Burch colposuspension and autologousfascial sling. However, urologists today have little indication to perform colposuspension save for open abdominal sacrocolpopexy, for which anti-incontinence surgery is needed, and even that is debatable. In the present era in which there are many mid urethral polypropylene slings from which to choose, the data are more mature and patients are requesting less invasive surgeries, thus they seem to have become the standard of care for SUI in almost every United States community. Level I evidence from the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) reports the autologous fascial sling to be superior to colposuspension with regard to stress incontinence cure. In addition, the prospective randomized trial by Ward et al demonstrates equivalence between the tension-free vaginal tape procedure and colposuspension for cure of SUI at 5 years. Today practice patterns reflect a preference for mid urethral slings for the treatment of SUI. Urinary incontinence outcomes data and clinical experience prove that no procedure is foolproof. In this issue of The Journal Daneshgari et al (page 1890) make a compelling argument that we must improve the reporting of complications (current statistics likely underestimate the incidence) as well as search for factors that could help prevent them. Identifying criteria that would improve our ability to select the optimal procedure for cure and the reduction of complications would be advantageous.