Open Retropubic Colposuspension for Urinary Incontinence in Women: A Short Version Cochrane Review

Marie Carmela M. Lapitan, Dorothy June Cody, Adrian Maxwell Grant

Research output: Contribution to journalLiterature review

12 Citations (Scopus)

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 Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria: Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Data Collection and Analysis: Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results: This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9-88.0% for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic 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 0.34-0.76 before the first year, RR 0.43; 95% CI 0.32-0.57 at 1-5 years, RR 0.49; 95% CI 0.32-0.75 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 0.42-1.03), after the first year (RR 0.48; 95% CI 0.33-0.71), and beyond 5 years (RR 0.32; 95% CI 15-0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up 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 0.18-0.76) than after the Marshall-Marchetti-Krantz procedure at 1-5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions: The evidence available indicates that open retropubic colposuspension is an 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 5 years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out.
Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol

Original languageEnglish
Pages (from-to)472-480
Number of pages9
JournalNeurourology and Urodynamics
Volume28
Issue number6
Early online date9 Jul 2009
DOIs
Publication statusPublished - Aug 2009

Keywords

  • Cochrane review
  • open retropubic colposuspension
  • urinary incontinence
  • women
  • genuine stress-incontinence
  • randomized clinical-trial
  • bladder neck suspension
  • free vaginal tape
  • modified Burch colposuspension
  • Marchetti-Krantz urethropexy
  • Anterior colporrhaphy
  • low-pressure
  • surgery
  • management

Cite this

Open Retropubic Colposuspension for Urinary Incontinence in Women : A Short Version Cochrane Review. / Lapitan, Marie Carmela M.; Cody, Dorothy June; Grant, Adrian Maxwell.

In: Neurourology and Urodynamics, Vol. 28, No. 6, 08.2009, p. 472-480.

Research output: Contribution to journalLiterature review

Lapitan, Marie Carmela M. ; Cody, Dorothy June ; Grant, Adrian Maxwell. / Open Retropubic Colposuspension for Urinary Incontinence in Women : A Short Version Cochrane Review. In: Neurourology and Urodynamics. 2009 ; Vol. 28, No. 6. pp. 472-480.
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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 Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria: Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Data Collection and Analysis: Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results: This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9-88.0{\%} for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic 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 0.34-0.76 before the first year, RR 0.43; 95{\%} CI 0.32-0.57 at 1-5 years, RR 0.49; 95{\%} CI 0.32-0.75 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 0.42-1.03), after the first year (RR 0.48; 95{\%} CI 0.33-0.71), and beyond 5 years (RR 0.32; 95{\%} CI 15-0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up 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 0.18-0.76) than after the Marshall-Marchetti-Krantz procedure at 1-5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions: The evidence available indicates that open retropubic colposuspension is an 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 5 years, approximately 70{\%} of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol",
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TY - JOUR

T1 - Open Retropubic Colposuspension for Urinary Incontinence in Women

T2 - A Short Version Cochrane Review

AU - Lapitan, Marie Carmela M.

AU - Cody, Dorothy June

AU - Grant, Adrian Maxwell

PY - 2009/8

Y1 - 2009/8

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 Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria: Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Data Collection and Analysis: Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results: This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9-88.0% for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic 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 0.34-0.76 before the first year, RR 0.43; 95% CI 0.32-0.57 at 1-5 years, RR 0.49; 95% CI 0.32-0.75 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 0.42-1.03), after the first year (RR 0.48; 95% CI 0.33-0.71), and beyond 5 years (RR 0.32; 95% CI 15-0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up 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 0.18-0.76) than after the Marshall-Marchetti-Krantz procedure at 1-5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions: The evidence available indicates that open retropubic colposuspension is an 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 5 years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol

AB - 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 Specialized Register (searched June 30, 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies. Selection Criteria: Randomized or quasi-randomized controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Data Collection and Analysis: Studies were evaluated for methodological quality/susceptibility to bias and appropriateness for inclusion and data extracted by two of the reviewers. Trial data were analyzed by intervention. Where appropriate, a summary statistic was calculated. Main Results: This review included 46 trials involving a total of 4,738 women. Overall cure rates were 68.9-88.0% for open retropubic colposuspension. Two small studies suggest lower failure rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggests lower failure rates after open retropubic colposuspension compared to anticholinergic 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 0.34-0.76 before the first year, RR 0.43; 95% CI 0.32-0.57 at 1-5 years, RR 0.49; 95% CI 0.32-0.75 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 0.42-1.03), after the first year (RR 0.48; 95% CI 0.33-0.71), and beyond 5 years (RR 0.32; 95% CI 15-0.71). Evidence from 12 trials in comparison with suburethral slings found no significant difference in failure rates in all time periods assessed. Patient-reported failure rates in short, medium and long-term follow-up 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 0.18-0.76) than after the Marshall-Marchetti-Krantz procedure at 1-5-year follow-up. There were few data at any other follow-up time. In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension, compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Authors' Conclusions: The evidence available indicates that open retropubic colposuspension is an 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 5 years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet. Neurourol

KW - Cochrane review

KW - open retropubic colposuspension

KW - urinary incontinence

KW - women

KW - genuine stress-incontinence

KW - randomized clinical-trial

KW - bladder neck suspension

KW - free vaginal tape

KW - modified Burch colposuspension

KW - Marchetti-Krantz urethropexy

KW - Anterior colporrhaphy

KW - low-pressure

KW - surgery

KW - management

U2 - 10.1002/nau.20780

DO - 10.1002/nau.20780

M3 - Literature review

VL - 28

SP - 472

EP - 480

JO - Neurourology and Urodynamics

JF - Neurourology and Urodynamics

SN - 0733-2467

IS - 6

ER -