Objective cure rates exceeding 75% are reported after colposuspension in women with stress incontinence, but extended follow-up has not been the rule. Small-scale studies also have been done to evaluate laparoscopic colposuspension after its introduction in 1991. A Cochrane review in the year 2000 yielded no conclusions about the long-term efficacy of this procedure.
The present randomized controlled trial recruited, from six gynecology units in the United Kingdom, 291 women with proven stress urinary incontinence who required surgery. Participants were randomized to undergo open abdominal retropubic colposuspension or laparoscopic colposuspension. Subjective outcomes were based on patient satisfaction, and objective outcomes on a negative 1-hour pad test. Data on objective outcomes were available after 2 years of follow-up in 85% of women having laparoscopic surgery and 80% of those having open surgery. The respective figures for subjective outcomes were 89% and 87.5%.
Clinical outcomes, judged objectively, did not differ significantly between the two treatment groups. Objective cure rates were consistently higher than subjectively determined rates. Estimates of efficacy were very similar when made by intention-to-treat analysis and the adjusted treatment received technique. Objective results deteriorated slowly but significantly over time in women having either the open or the laparoscopic procedure. There was no similar trend for subjective cure rates. High levels of postoperative pain were more frequent in those having open surgery. Time in hospital was not significantly less after laparoscopic surgery. Bladder and bowel injuries were uncommon but were more frequent in patients having laparoscopic surgery. Wound infections were more prevalent after open surgery. No group difference in quality of life was evident 6 weeks after surgery. The mean time before returning to work was 9–10 weeks for women in both treatment groups.
When done by a skilled endoscopist, laparoscopic colposuspension is as effective as open surgery for treating women with stress urinary incontinence.
Division of Human Development and Division of Epidemiology and Health Sciences, University of Manchester, Manchester, United Kingdom; Warrell Unit, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom