SOGC CLINICAL PRACTICE GUIDELINE Choice of Surgery for Stress Incontinence

Objective: To outline the evidence for the efficacy of surgical procedures used for the primary treatment of urinary incontinence. Options: The range of surgical options available for the primary treatment of urinary incontinence in women. Outcomes: The best possible outcomes for women undergoing primary surgery for urinary incontinence. To provide a current understanding of the evidence available as the basis of an informed discussion of the anticipated outcome of surgery. Evidence: A systematic review of clinical trials of the outcomes of primary surgical treatment of urinary incontinence. Values: The quality of the evidence is rated using the criteria described by the Canadian Task Force on periodic health examination (Table). Benefits, Harms, and Costs: Careful consideration of the surgical options available will result in informed choice, which is essential to the process of determining the most appropriate surgery for a woman. Use of a range of surgeries that have the highest proven efficacy is most likely to result in long-term patient satisfaction. Recommendations: 1. When considering a primary surgical correction of stress urinary incontinence women should be informed that, according to current available evidence, a retropubic procedure provides the best assurance of a durable cure ( I-A). 2. Some surgeons offer laparoscopic Burch as an alternative to the open Burch. Currently available short-term evidence does not clearly demonstrate an advantage or disadvantage over the open Burch (I-A). 3. The tension-free vaginal tape procedure (TVT) has demonstrated short-term equivalency to retropubic procedures and may be offered as a primary surgery with the proviso that it has not been rigorously tested for long-term equivalency. There is insufficient evidence to permit informed recommendations concerning other sling procedures (I-A). 4. Anterior colporrhaphy should generally not be offered to women as a treatment for isolated primary stress urinary incontinence because of higher failure rates (I-A). 5. Needle suspensions should generally not be offered to women as a treatment for isolated primary stress urinary incontinence because of higher failure rates (I-A). 6. Periurethral injection of bulking agents should generally not be offered to women for the treatment of primary stress urinary incontinence because of anticipated high failure rates (III-C). J Obstet Gynaecol Can 2005;27(10):964–971