UTRECHT, NETHERLANDS (Press Release) - September 18, 2013 - A new Dutch study, headed by University Medical Center Utrecht, has shown that in women with moderate-to-severe stress urinary incontinence, surgery is more effective than physiotherapy, which is the current standard treatment.
Publishing their results in the New England Journal of Medicine this week, the researchers 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.
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| Huub van der Vaart |
In the PORTRET study (Physiotherapy OR Tension free tape Randomized Efficacy Trial), 460 women aged 35 and older suffering from moderate-to-severe stress urinary incontinence 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 plastic mid-urethral sling below the urethra to support it, thus preventing involuntary urine loss.
One year later, the doctors checked whether these treatments had been effective. The study showed that surgery is clearly more effective than pelvic floor therapy. A subjective improvement occurred in 90.8 per cent of the women who had had surgery, compared to 64.4 per cent of the women who had started pelvic floor physiotherapy (of this group, 49 per cent was also operated on within a year). In the group who had undergone surgery, there were also more women that were completely cured (85.2%) than in the pelvic floor therapy group (53.4%). About 1 in 10 women had mild complications (such as bruising or urge incontinence), which was entirely due to the surgery. While the complications did not have any permanent adverse effects, there were no such complications with pelvic floor therapy.
Modification of the guidelines
Prof. Huub van der Vaart, MD, PhD, gynecologist at UMC Utrecht and co-author of the study, said, “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.”
Stress urinary incontinence a common complaint
Stress urinary incontinence (involuntary leakage of urine during physical exertion, jumping, sneezing or coughing) is a common problem in women (1 in 4 women aged 35 and older suffers from it) and can affect the quality of life. In the case of stress urinary incontinence, the patient loses urine from the bladder during activities that increase intra-abdominal pressure. Normally, the pelvic floor connective tissue below the urethra closes it during physical exertion. Damage to the pelvic floor, for instance resulting from childbirth, may cause loss of support of the urethra, which in turn leads to involuntary loss of urine.
Reference:
Labrie J et al. Surgery versus physiotherapy for stress incontinence. New England Journal of Medicine 2013;369:1124-1133
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University Medical Center Utrecht
The University Medical Center Utrecht (UMC Utrecht) is one of the largest public healthcare institutions in the Netherlands. It employs almost 11,000 people who are working continuously on providing care, with people and knowledge as the two cornerstones. There are 3,350 students at the medical faculty. Around 2,800 babies are born at UMC Utrecht every year, and there are 29,000 day care treatments, 33,000 hospital admissions and 340,000 outpatient clinic appointments. UMC Utrecht aims to be a leading university medical center internationally, a center where knowledge about health, disease and healthcare is generated, validated, shared and applied. UMC Utrecht is part of the (NFU), the Dutch Federation of University Medical Centers.
University Medical Center Utrecht
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