Chirurgie of fysiotherapie voor stressincontinentie*

Objective

To compare midurethral sling surgery and pelvic floor physiotherapy as initial treatment in women with moderate to severe urinary stress incontinence.

Design

Multicentre randomised trial.

Method

The study population was made up of women aged 35 to 80 years with moderate to severe stress incontinence. They received surgical treatment or pelvic floor physiotherapy, having been stratified according to incontinence severity. Crossover between groups was allowed during the follow-up period. Improvement at 12 months follow-up measured with the Patient Global Impression of Improvement score was the primary outcome measure (Dutch Trial Register number: NTR1248).

Results

We randomised 230 women to the sling surgery group and 230 to pelvic floor physiotherapy group. A total of 49% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. An improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference: 26.4 percentage points; 95% confidence interval: 18.1 to 34.5). A post hoc per-protocol analysis showed that women who underwent additional surgery after physiotherapy had similar outcomes to women initially assigned to surgery.

Conclusion

The symptoms of women with moderate to severe stress incontinence were improved more with midurethral sling surgery than with pelvic floor exercises at 1 year.

Conflict of interest: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A7233; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Financial support for this article: J. Labrie and C.H. van der Vaart received a research grant from the Netherlands Organisation for Health Research and Development (ZonMw Doelmatigheidsonderzoek).