Surgery for stress incontinence: A non-randomised trial of colposuspension, needle suspension and anterior colporrhaphy

Objective: To compare the outcome, 12 months after surgery, of three princi pal categories of procedure (colposuspension, needle suspension and anterio r colporrhaphy) used for treating stress incontinence. Methods: A non-randomised trial design comparing 221 colposuspensions, 54 n eedle suspensions and 130 anterior colporrhaphies performed by 49 surgeons in 18 hospitals in the North Thames health region in 1993-1994. Four outcom es were considered: complications, severity of stress incontinence, social impact of incontinence, and activities of daily living score. Results were adjusted, using logistic regression, for 13 case-mix variables. Results: Significant differences existed between the three procedures in th e characteristics of the patients. The cure rate varied by procedure (colpo suspension 34% dry; needle suspensions 13%; anterior colporrhaphy 19%). Two thirds of women, however, reported an improvement (colposuspension 75%; ne edle suspension 68%; anterior colporrhaphy 55%). After adjusting for confou nders, colposuspension was significantly more likely to result in an improv ement than anterior colporrhaphy (odds ratio 2.2). While this was reflected in improvements in the social life of the women, the difference between pr ocedures did not reach statistical significance (p = 0.05). Conclusion: These results suggest surgery for stress incontinence in typica l settings is not as good as reported in textbooks. This is mostly because this study was based on women's own reports (and not surgeons' reports) and partly because of the unselected nature of the patients. The information o n outcomes given to patients should be reviewed and a large, pragmatic rand omised trial including patient-assessed outcomes is needed. Copyright (C) 2 001 S. Karger AG, Basel.