Surgery offers mixed blessings for incontinence

BOSTON (Reuters) - Surgery that uses an internal sling to support the body's urine tube worked better to fix a type of incontinence in women than another method, but any procedure is unlikely to work perfectly, doctors reported on Monday.

They found women were happier with a procedure that uses a sling of tendon, muscle or other material to hold the urine tube than another technique that anchors the tube to ligament for preventing urine leakage.

But the sling method also tends to produce more long-term side effects, according to the report, to be published in Thursday's New England Journal of Medicine.

Doctors should discuss the trade-offs with their patients and "emphasize that complete resolution of incontinence symptoms after surgery is unlikely," Dr. Michael Albo of the University of California San Diego and his colleagues wrote in their report, released to coincide with a meeting of the American Urological Association.

Both techniques are designed to reduce urinary stress incontinence by lifting the urethra into the normal position after it has dropped with age.

Up to 10 percent of U.S. women have some kind of surgery to prevent leakage, particularly when they cough, sneeze or strain, and as many as 40 percent of older woman have some degree of incontinence.

"For the first time, we have a meticulous, relatively long-term comparison of these common surgeries in women," Dr. Leroy Nyberg, director of urology research at the National Institute of Diabetes and Digestive and Kidney Diseases, which paid for the study, said in a statement.

In the study, which followed women for two years, surgery was considered successful by asking whether a woman reported leaking or whether she leaked while coughing.

The Albo team found that the technique using ligament, muscle or tendon to create a sling for the urethra worked in 66 percent of the 326 women, compared to a 49 percent success rate for the 329 women treated with the anchoring technique, also known as Burch colposuspension.

But the sling made women more prone to urinary tract infections, the women sometimes found it harder to urinate, and they were more likely to suffer from urge incontinence, which is the sudden need to urinate.

The reported success rate for both procedures in other studies have ranged from 70 to 90 percent.