Utah women participated in a national study released today that showed one particular surgery for "stress urinary incontinence" is better than another at keeping women dry. But this option also leads to negative side effects, including urinary tract infections and difficulty urinating.
Stress incontinence affects up to 50 percent of women, according to some estimates, though it is bothersome only to about 15 percent of women. Incontinence can have negative emotional consequences - women may give up activities like exercise, and they can suffer from low self-esteem.
"People who are perfectly healthy but coughed at a party and had a huge spurt of urine all over their white pants, [the interference in their quality of life] is just as bad as someone with chronic kidney failure," said Peggy Norton, one of the study's authors and an associate professor of obstetric and gynecology at the University of Utah.
Utah was one of nine study sites that compared two common surgeries for the most prevalent form of incontinence. Both surgeries aim to add support to pinch off the urethra.
One inserts a sling made of a woman's own tissue; the other, the Burch procdure, attaches sutures to underlying ligaments.
The women were randomly assigned to have one of the two surgeries, and neither they nor the surgeons knew which surgery they would be getting beforehand.
Two years after the surgery, women were more satisfied with the sling, which also showed less leakage.
The findings are significant because the study, funded by the National Institutes of Health, is the largest and most rigorous U.S. trial comparing the two surgeries, according to the NIH.
The study will be published in the New England Journal of Medicine this week, and Norton is presenting the findings to the American Urological Association in California today.
"Every woman needs information so that she can make a decision, along with her surgeon, about will it improve my quality of life . . . and what might the risks be to me? Having numbers about what happens to other folks really does help in the counseling," said Norton, who performs surgeries on incontinent women.
Beverly Beasley had the sling surgery 15 years ago after suffering from stress incontinence for most of her life. "I'm a ski instructor and it was not helpful. You jump up - and boom," said the 59-year-old Sandy woman.
She wasn't part of the study, but she confirmed the sling is effective. "I can do anything. I can jump on trampolines. I can do jumping jacks. It keeps me active, and I'm old."
Stress incontinence is most common among women in their 40s and 50s. Women who have given birth are at a higher risk of incontinence. Being overweight is also a risk factor.
The problem is weak pelvic floor or urethral sphincter muscles.
"It's like somebody just dropped a 30-pound weight on your bladder," Norton said.
The surgeon would rather patients avoid surgery. Prevention methods could include Caesarean sections in women who are at higher risk of incontinence, she said. Other treatments include exercises to strengthen the pelvic floor, changing fluid intake and losing weight.
About 250,000 women seek surgery for incontinence each year. The Burch and sling surgeries are two of the most common, though mesh synthetic slings are taking over in popularity because they offer faster recovery times and fewer complications.
Norton is currently helping study the mesh slings, noting that the other studies to date have been funded by mesh manufacturers. She is also involved in a study of Utah women to learn if incontinence runs in families, with the goal of eventually preventing it.
