Laparoscopic colposuspension for urinary incontinence in women
Abstract
Background
Laparoscopic colposuspension is a relatively new operation for the treatment of women with stress urinary incontinence with the presumed advantages over traditional Burch colposuspension of avoiding major incisions, shorter hospital stay, and quicker return to normal activities. A variety of approaches and methods are used.
Objectives
To determine the effects of laparoscopic colposuspension surgery on urinary incontinence.
Search methods
We searched the Cochrane Incontinence Group specialised register. The date of the most recent search was April 2001. Additional trials were sought from other sources such as reference lists, conference proceedings, reviews and unpublished research.
Selection criteria
Randomised or quasi‐randomised controlled trials in women with symptomatic or urodynamic diagnosis of stress or mixed incontinence that included laparoscopic surgery in at least one arm of the study.
Data collection and analysis
Trials were evaluated for methodological quality and appropriateness for inclusion by the reviewers. Data were extracted by two of the reviewers and cross checked by another. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated.
Main results
Eight eligible trials were identified. Five included 233 women receiving a laparoscopic and 254 women an open colposuspension. Whilst the women's subjective impression of cure seemed similar for both procedures up to 18 months there was some evidence of poorer results on objective outcomes. A single trial suggested poorer long‐term performance, but this may reflect surgical inexperience of laparoscopic colposuspension.
No significant differences were observed for post‐operative urgency, voiding dysfunction or de novo detrusor instability. Trends were shown towards a higher complication rate, longer operating time, less intraoperative blood loss, less postoperative pain, shorter hospital stay, quicker return to normal activities, and shorter duration of catheterisation for laparoscopic compared with open colposuspension.
Significantly higher subjective and objective (dry on 'ultrashort' pad test) one year cure rates were found for women randomised to two paravaginal sutures compared with one suture in a single trial (89% vs 65% and 83% vs 58% respectively).
One study compared sutures with mesh and staples for laparoscopic colposuspension but it was too small to allow a reliable comparison.
One study compared transperitoneal with extraperitoneal access for laparoscopic colposuspension but it was also small and of poor quality.
Authors' conclusions
The long‐term performance of laparoscopic colposuspension is uncertain. Currently available evidence suggests that it may be poorer than open colposuspension. Like other laparoscopically performed operations, laparoscopic colposuspension leads to a quicker recovery, but takes longer to perform and may be associated with more surgical complications. If it is performed, two paravaginal sutures appear to be more effective than one. The place of laparoscopic colposuspension in clinical practice should become clearer when ongoing trials are reported and when there are more data available describing long‐term cure results.
PICOs
Plain language summary
Women recover more quickly from laparoscopic colposuspension for urinary incontinence than from traditional surgery, with similar initial improvement. Longer‐term success rates may be lower, but this is uncertain.
Stress urinary incontinence is loss of urine when coughing, laughing, sneezing or exercising. It can be caused by damage to the tissues that hold up the bladder. Laparoscopic colposuspension is an operation through a small incision in the abdomen, to tighten up the tissues around the neck of the bladder. The review of trials found that traditional colposuspension had technically better results and may be better longer‐term. However, women's experience of initial improvement was similar and they recovered more quickly from the laparoscopic type. Using two stitches was better than one, although it appeared not to matter whether stitches or mesh were used. A trend was shown towards better outcomes during the laparoscopic operation (postoperative pain, hospital stay, time to return to normal activities, intra operative blood loss, duration of catheterisation) but there were more complications later compared to open colposusupension.
