Anterior vaginal repair for urinary incontinence in women

Research output: Contribution to journalArticle

Abstract

Background

Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.
Objectives

To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.
Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.
Selection criteria

Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.
Data collection and analysis

Both reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.
Main results

Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.

A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95% CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.

Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.

In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.
Authors' conclusions

There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.
Original languageEnglish
Article numberCD001755
Number of pages74
JournalCochrane Database of Systematic Reviews
Issue number1
DOIs
Publication statusPublished - 22 Jan 2001

Fingerprint

Urinary Incontinence
Prolapse
Suspensions
Confidence Intervals
Stress Urinary Incontinence
Needles
Suburethral Slings
Reoperation
Urinary Bladder
Therapeutics
Research Personnel
Morbidity

Cite this

Anterior vaginal repair for urinary incontinence in women. / Glazener, Cathryn M. A.; Cooper, Kevin.

In: Cochrane Database of Systematic Reviews, No. 1, CD001755, 22.01.2001.

Research output: Contribution to journalArticle

@article{b9388c17a1e04a308f274c42b74e5892,
title = "Anterior vaginal repair for urinary incontinence in women",
abstract = "BackgroundAnterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.ObjectivesTo determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.Search methodsWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.Selection criteriaRandomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.Data collection and analysisBoth reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.Main resultsTen trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95{\%} CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38{\%}) versus 57/327 (17{\%}); relative risk (RR) 2.29, 95{\%} confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38{\%}) versus 31/145 (21{\%}); RR 2.02, 95{\%} CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23{\%}) versus 4/164 (2{\%}); RR 8.87, 95{\%} CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95{\%} CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3{\%}) or abdominal (4{\%}) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.Authors' conclusionsThere were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.",
author = "Glazener, {Cathryn M. A.} and Kevin Cooper",
year = "2001",
month = "1",
day = "22",
doi = "10.1002/14651858.CD001755",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Wiley",
number = "1",

}

TY - JOUR

T1 - Anterior vaginal repair for urinary incontinence in women

AU - Glazener, Cathryn M. A.

AU - Cooper, Kevin

PY - 2001/1/22

Y1 - 2001/1/22

N2 - BackgroundAnterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.ObjectivesTo determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.Search methodsWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.Selection criteriaRandomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.Data collection and analysisBoth reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.Main resultsTen trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95% CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.Authors' conclusionsThere were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.

AB - BackgroundAnterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.ObjectivesTo determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.Search methodsWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.Selection criteriaRandomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.Data collection and analysisBoth reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.Main resultsTen trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95% CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.Authors' conclusionsThere were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.

U2 - 10.1002/14651858.CD001755

DO - 10.1002/14651858.CD001755

M3 - Article

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 1

M1 - CD001755

ER -