Anterior vaginal repair for urinary incontinence in women

Glazener CMA, Cooper K

Published Online:

January 20, 2010

Urinary incontinence is the inability to prevent urine leakage. Stress urinary incontinence is loss of urine when a person coughs or exercises. Damage to the muscles that hold up the bladder, and injuries to the nerves during childbirth, may be causes. When non-surgical methods, such as exercising the muscles in the pelvic floor (the base of the abdomen), have not worked, surgery is sometimes used to lift and support the bladder. Anterior vaginal repair aims to achieve this, operating through the vaginal wall. The review of ten trials in 1012 women found some evidence that surgery through the abdomen may be better than vaginal repair. However, there was not enough information about side-effects, or in comparison with other physical or surgical methods of treating urine leakage.

Abstract (click to read)

Background:

Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.

Objectives:

To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.

Selection criteria:

Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.

Data collection and analysis:

Both reviewers independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.

Main results:

Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.

A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (RR for failure after one year 1.16, 95% CI 0.86 to 1.56) but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.

Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); relative risk (RR) 2.29, 95% confidence Interval (CI) 1.7 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.

In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.

Authors' conclusions:

There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.

This record should be cited as:

Glazener CMA, Cooper K. Anterior vaginal repair for urinary incontinence in women. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD001755. DOI: 10.1002/14651858.CD001755

Assessed as up to date:

September 7, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Urinary incontinence > Surgery

Urology > Incontinence > Surgery

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Anterior vaginal repair for urinary incontinence in women

More like this

Copyright © 2012 - The Cochrane Collaboration