Open retropubic colposuspension for urinary incontinence in women

Marie Carmela M. Lapitan, June D Cody, Adrian Grant

Research output: Contribution to journalLiterature review

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 (searched 30 June 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies.

Selection criteria

Randomised or quasi-randomised 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 analysed by intervention. Where appropriate, a summary statistic was calculated.

Main results

This review included 46 trials involving a total of 4738 women.

Overall cure rates were 68.9% to 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 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 five years (RR 0.32; 95% CI 15 to 0.71). Evidence from twelve 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 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five 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 to 90%. After five years, approximately 70% of 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 and closer monitoring of its adverse event profile must be done. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.

Original languageEnglish
Article numberCD002912
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 7 Oct 2009

Keywords

  • *Suburethral Slings
  • Gynecologic Surgical Procedures [*methods]
  • Randomized Controlled Trials as Topic
  • Suture Techniques
  • Urinary Incontinence [*surgery]
  • Urinary Incontinence, Stress [surgery]
  • Urologic Surgical Procedures [*methods]
  • Vagina [surgery]
  • Female
  • Humans
  • Free Vaginal Tape
  • Genuine Stress-Incontinence
  • Randomized controlled-trials
  • Open Burch Colposuspension
  • Bladder Neck Suspension
  • 5-Year Follow-Up
  • Marchetti-Krantz Urethropexy
  • Pelvic Organ Prolapse
  • Leak Point Pressure
  • Laparoscopic Colposuspension

Cite this

Open retropubic colposuspension for urinary incontinence in women. / Lapitan, Marie Carmela M.; Cody, June D; Grant, Adrian.

In: Cochrane Database of Systematic Reviews, No. 4, CD002912, 07.10.2009.

Research output: Contribution to journalLiterature review

Lapitan, Marie Carmela M. ; Cody, June D ; Grant, Adrian. / Open retropubic colposuspension for urinary incontinence in women. In: Cochrane Database of Systematic Reviews. 2009 ; No. 4.
@article{3ce7db42e1af4c51b5c2594f2ddd0019,
title = "Open retropubic colposuspension for urinary incontinence in women",
abstract = "BackgroundUrinary 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.ObjectivesTo assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.Search strategyWe searched the Cochrane Incontinence Group Specialised Register (searched 30 June 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies.Selection criteriaRandomised or quasi-randomised 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 analysisStudies were evaluated for methodological quality/susceptibility to bias 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 resultsThis review included 46 trials involving a total of 4738 women.Overall cure rates were 68.9{\%} to 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 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 five years (RR 0.32; 95{\%} CI 15 to 0.71). Evidence from twelve 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 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five 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' conclusionsThe 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 to 90{\%}. After five years, approximately 70{\%} of 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 and closer monitoring of its adverse event profile must be done. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.",
keywords = "*Suburethral Slings, Gynecologic Surgical Procedures [*methods], Randomized Controlled Trials as Topic, Suture Techniques, Urinary Incontinence [*surgery], Urinary Incontinence, Stress [surgery], Urologic Surgical Procedures [*methods], Vagina [surgery], Female, Humans, Free Vaginal Tape, Genuine Stress-Incontinence, Randomized controlled-trials, Open Burch Colposuspension, Bladder Neck Suspension, 5-Year Follow-Up, Marchetti-Krantz Urethropexy, Pelvic Organ Prolapse, Leak Point Pressure, Laparoscopic Colposuspension",
author = "Lapitan, {Marie Carmela M.} and Cody, {June D} and Adrian Grant",
year = "2009",
month = "10",
day = "7",
doi = "10.1002/14651858.CD002912.pub4",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Wiley",
number = "4",

}

TY - JOUR

T1 - Open retropubic colposuspension for urinary incontinence in women

AU - Lapitan, Marie Carmela M.

AU - Cody, June D

AU - Grant, Adrian

PY - 2009/10/7

Y1 - 2009/10/7

N2 - BackgroundUrinary 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.ObjectivesTo assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.Search strategyWe searched the Cochrane Incontinence Group Specialised Register (searched 30 June 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies.Selection criteriaRandomised or quasi-randomised 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 analysisStudies were evaluated for methodological quality/susceptibility to bias 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 resultsThis review included 46 trials involving a total of 4738 women.Overall cure rates were 68.9% to 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 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 five years (RR 0.32; 95% CI 15 to 0.71). Evidence from twelve 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 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five 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' conclusionsThe 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 to 90%. After five years, approximately 70% of 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 and closer monitoring of its adverse event profile must be done. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.

AB - BackgroundUrinary 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.ObjectivesTo assess the effects of open retropubic colposuspension for the treatment of urinary incontinence.Search strategyWe searched the Cochrane Incontinence Group Specialised Register (searched 30 June 2008) and reference lists of relevant articles. We contacted investigators to locate extra studies.Selection criteriaRandomised or quasi-randomised 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 analysisStudies were evaluated for methodological quality/susceptibility to bias 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 resultsThis review included 46 trials involving a total of 4738 women.Overall cure rates were 68.9% to 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 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 five years (RR 0.32; 95% CI 15 to 0.71). Evidence from twelve 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 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five 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' conclusionsThe 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 to 90%. After five years, approximately 70% of 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 and closer monitoring of its adverse event profile must be done. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness is not known yet.

KW - Suburethral Slings

KW - Gynecologic Surgical Procedures [methods]

KW - Randomized Controlled Trials as Topic

KW - Suture Techniques

KW - Urinary Incontinence [surgery]

KW - Urinary Incontinence, Stress [surgery]

KW - Urologic Surgical Procedures [methods]

KW - Vagina [surgery]

KW - Female

KW - Humans

KW - Free Vaginal Tape

KW - Genuine Stress-Incontinence

KW - Randomized controlled-trials

KW - Open Burch Colposuspension

KW - Bladder Neck Suspension

KW - 5-Year Follow-Up

KW - Marchetti-Krantz Urethropexy

KW - Pelvic Organ Prolapse

KW - Leak Point Pressure

KW - Laparoscopic Colposuspension

U2 - 10.1002/14651858.CD002912.pub4

DO - 10.1002/14651858.CD002912.pub4

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

M1 - CD002912

ER -