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Open retropubic colposuspension for urinary incontinence in women.

Abstract

BACKGROUND

Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure.

OBJECTIVES

To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group specialised register (to April 2002) and reference lists of relevant articles. We contacted investigators to locate extra studies. Date of the most recent search: April 2002.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed incontinence that included open retropubic colposuspension surgery in at least one trial group.

DATA COLLECTION AND ANALYSIS

Studies were evaluated for methodological quality and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated.

MAIN RESULTS

This review included 33 trials involving a total of 2403 women. Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggests lower failure rates after open retropubic colposuspension than conservative treatment. Evidence from six trials showed a lower failure rate for subjective cure after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (RR of failure 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond 5 years). In comparison with needle suspensions there was a lower failure rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71) and beyond 5 years (RR 0.32; 95% CI 15 to 0.71). Evidence from three trials in comparison with suburethral slings found no significant difference in failure rates. Patient-reported failure rates in short-, medium- and long-term follow-ups showed no significant difference between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials failure was less common after Burch (RR 0.38 95% CI 0.18 to 0.76) as than the Marshall Marchetti Krantz procedure at one to five year follow-up There were few data at any other follow-up. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures.

REVIEWER'S CONCLUSIONS

The evidence available indicates that Open retropubic colposuspension is the most effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85-90%. After five years, approximately 70% patients can expect to be dry. Newer minimal access procedures like tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.

Authors+Show Affiliations

Department of Surgery, National Institutes of Health, University of the Philippines, Manila, Philippines. mela@info.com.phNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

12535443

Citation

Lapitan, M C., et al. "Open Retropubic Colposuspension for Urinary Incontinence in Women." The Cochrane Database of Systematic Reviews, 2003, p. CD002912.
Lapitan MC, Cody DJ, Grant AM. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2003.
Lapitan, M. C., Cody, D. J., & Grant, A. M. (2003). Open retropubic colposuspension for urinary incontinence in women. The Cochrane Database of Systematic Reviews, (1), CD002912.
Lapitan MC, Cody DJ, Grant AM. Open Retropubic Colposuspension for Urinary Incontinence in Women. Cochrane Database Syst Rev. 2003;(1)CD002912. PubMed PMID: 12535443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Open retropubic colposuspension for urinary incontinence in women. AU - Lapitan,M C, AU - Cody,D J, AU - Grant,A M, PY - 2003/1/22/pubmed PY - 2003/3/28/medline PY - 2003/1/22/entrez SP - CD002912 EP - CD002912 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. OBJECTIVES: To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised register (to April 2002) and reference lists of relevant articles. We contacted investigators to locate extra studies. Date of the most recent search: April 2002. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed incontinence that included open retropubic colposuspension surgery in at least one trial group. DATA COLLECTION AND ANALYSIS: Studies were evaluated for methodological quality and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. MAIN RESULTS: This review included 33 trials involving a total of 2403 women. Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggests lower failure rates after open retropubic colposuspension than conservative treatment. Evidence from six trials showed a lower failure rate for subjective cure after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (RR of failure 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond 5 years). In comparison with needle suspensions there was a lower failure rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71) and beyond 5 years (RR 0.32; 95% CI 15 to 0.71). Evidence from three trials in comparison with suburethral slings found no significant difference in failure rates. Patient-reported failure rates in short-, medium- and long-term follow-ups showed no significant difference between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials failure was less common after Burch (RR 0.38 95% CI 0.18 to 0.76) as than the Marshall Marchetti Krantz procedure at one to five year follow-up There were few data at any other follow-up. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. REVIEWER'S CONCLUSIONS: The evidence available indicates that Open retropubic colposuspension is the most effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85-90%. After five years, approximately 70% patients can expect to be dry. Newer minimal access procedures like tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12535443/Open_retropubic_colposuspension_for_urinary_incontinence_in_women_ L2 - https://doi.org/10.1002/14651858.CD002912 DB - PRIME DP - Unbound Medicine ER -