Picture: Outline of a sling surgery 
Illustration of the sling procedure
© National Institute of Diabetes
and Digestive and Kidney Diseases

"For the first time, we have a meticulous, relatively long-term comparison of these common surgeries in women," said Leroy M. Nyberg Jr., Ph.D., M.D., director of urology research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) found that significantly more women with a sling made from the patient's own tissue and placed around the urethra for additional support were dry, compared to women with a Burch colposuspension, in which sutures are attached to a pelvic ligament to support the urethra.

Two years after surgery, 47 percent of women who had the sling procedure and 38 percent who had a Burch were dry overall, including leakage that could have been caused by urge incontinence. Considering only stress-specific leakage, 66 percent of women with a sling and 49 percent with a Burch procedure were dry.

SISTEr randomized 655 women with either pure stress urinary incontinence (SUI) or a combination of stress and urge incontinence to receive a fascial sling or a Burch. Complete information on measures used to assess urinary incontinence was available for 520 participants 24 months after surgery. While most women in the study were satisfied with the results of treatment, those with a sling were significantly more satisfied. Eighty-six percent with a sling were satisfied, compared to 78 percent of the Burch group.

Side effects were more common among women with slings, tempering the positive results of the procedure. The most common side effect was urinary tract infections, which occurred in 63 percent of women with a sling and 47 percent of the Burch group. Women with a sling also had more voiding problems (14 percent versus 2 percent) and persistent urge incontinence, the loss of urine just before feeling a strong, sudden urge to empty the bladder (27 percent versus 20 percent).

MEDICA.de; Source: NIH/National Institute of Diabetes and Digestive and Kidney Diseases