Clinical Results

Many studies have reported clinical experiences with retropubic urethral suspension procedures for stress urinary incontinence. Although most of these studies are methodologically flawed, increasing numbers of quality studies, including prospective randomized trials, have been or are being conducted. Currently, however, few prospec tive studies are available comparing the results of the various procedures for urodynamic stress incontinence.

Only a few studies have been done assessing the paravaginal defect repair for stress incontinence. Early studies using subjective outcome measures reported that more than 90% of women were continent after this procedure. However, in a prospective randomized trial, Colombo et al.6 found that only 61% of women were continent 3 years after a paravaginal defect repair compared with 100% of women continent after a Burch colposuspension. We currently believe that the paravaginal defect repair should be used for anatomic correction of anterior vaginal wall prolapse (cystocele), but not as primary treatment of urodynamic stress incontinence.

The Burch colposuspension is the best studied of the retropubic procedures. From 1980 to 1990,18 studies were reported using the Burch colposuspension in women with urodynamically proved stress incontinence and with objective measures of cure.7 Follow-up times in most studies ranged from 1 to 7 years. At 3 to 24 months after surgery, 59% to 100% of patients became continent, for an overall average cure rate of 84%. At 3 to 7 years, continence rates ranged from 63% to 89%, for an average rate of 77%. Although objectively incontinent, a small percentage of additional patients were judged to be improved and satisfied with their surgical results. The overall reported absolute failure rate was 14% at 3 to 24 months and 14% at 5 to 7 years.

Several studies have now been done that have assessed women more than 10 years after undergoing a Burch procedure. Alcalay et al.8 followed a cohort of 109 women (out of a group of 366 eligible women) who underwent Burch colposuspension between 1974 and 1983. The mean follow-up interval was 13.8 years. Both subjective and objective outcome measures were collected during the follow-up period. The cure of incontinence was found to be time-dependent, with a decline for 10 to 12 years and then a plateau at 69%. Cure rates were significantly lower in woman who had had previous bladder neck surgery. Approximately 10% of patients required at least one additional surgery to cure her stress incontinence.8

Black and Downs9 published an excellent systematic review in 1996 describing the effectiveness of surgery for stress incontinence in women. The methodologic quality of studies was assessed especially including all of the randomized controlled trials to that time. Only two randomized controlled trials of colposuspension were available. The study noted that different methods of performing colposuspension (e.g., Burch colposuspension vs. MMK procedure) have not been shown to be associated with significant differences in outcome. There is preliminary evidence that laparoscopic colposuspension as well as open paravaginal defect repair may have somewhat lower cure rates than open Burch procedures. Colposuspension seems to be more effective than both anterior colporrhaphy and needle urethropexy procedures in curing and improving stress incontinence. Approximately 85% of women can expect to be continent 1 year after colposuspension compared with 50% to 70% after anterior colporrhaphy and needle suspension. Primary procedures are generally more effective than repeat procedures. The benefit of Burch colposuspension is maintained for at least 5 years,whereas the benefits from anterior colporrhaphy and needle suspension diminish quite rapidly. Of the four prospective studies comparing Burch colposuspension and sling procedures, none has reported a difference in cure, however defined, regardless of whether the operations were being performed as primary or secondary operations.

In a recent prospective multicenter randomized trial of Burch colposuspension and tension-free vaginal tape (TVT) procedure for urodynamic stress incontinence, no significant difference was found between the surgeries for objective cure rates: 66% in the TVT group and 57% in the colposuspen-sion group.10 Bladder injury was more common during the TVT procedure; delayed voiding, operation time, and return to normal activity were all longer after colposuspension.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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