Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial.
OBJECTIVE
To compare the pubovaginal sling and transurethral Macroplastique in the treatment of female stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD).


METHODS
A prospective randomised controlled trial comparing two surgical treatments for SUI and ISD.


METHODS
Tertiary referral urogynaecology unit in Australia.


METHODS
Women with SUI and ISD who were suitable for either surgical technique.


METHODS
Forty-five women with SUI and ISD were randomly allocated the pubovaginal sling (n = 22) or transurethral Macroplastique (n = 23). Subjective and objective success rates, patient satisfaction and cost measurements at six months and one year following surgery were the primary outcome measures. A telephone questionnaire survey was performed at a mean follow up period of 62 months (43-71).


METHODS
Comparison of success rates, complications and costs.


RESULTS
The symptomatic and patient satisfaction success rates were similar following the sling and Macroplastique with the objective success rate being significantly greater (P < 0.001) following the sling (81%vs 9%). Macroplastique had significantly lower morbidity but was more expensive than the sling (P < 0.001). Response rate at 62 months follow up was 60% in both groups with the sling group reporting better continence success (69%vs 21%) and satisfaction rates (69%vs 29%, P = 0.057).


CONCLUSIONS
The pubovaginal sling was more effective and economical than transurethral Macroplastique for the treatment of SUI and ISD. However, transurethral Macroplastique remains an appropriate treatment in selected cases of SUI and ISD.
Maher
Christopher F
CF
Urogynaecology Unit, Mercy Hospital for Women and Royal Women's Hospital, Melbourne, Australia.
O'Reilly
Barry A
BA
Dwyer
Peter L
PL
Carey
Marcus P
MP
Cornish
Anne
A
Schluter
Philip
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012826:Silicone Elastomers / Q000008:administration & dosage*; D013526:Surgical Mesh; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D012826:Silicone Elastomers