title: Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial.
abstract: 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.
authors.affiliation: Urogynaecology Unit, Mercy Hospital for Women and Royal Women's Hospital, Melbourne, Australia.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Maher
authors.forename: Barry A
authors.initials: BA
authors.lastname: O'Reilly
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Carey
authors.forename: Anne
authors.initials: A
authors.lastname: Cornish
authors.forename: Philip
authors.initials: P
authors.lastname: Schluter
mesh_terms: 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*
chemical_list: D012826:Silicone Elastomers