Surgery versus physiotherapy for stress urinary incontinence.

Area of Science:

• Urology
• Gynecology
• Pelvic Health

Background:

• Physiotherapy with pelvic-floor muscle training is a first-line treatment for stress urinary incontinence.
• Midurethral-sling surgery is typically recommended for patients unresponsive to physiotherapy.
• Limited randomized trial data exist comparing these treatments as initial therapy.

Purpose of the Study:

• To compare the efficacy of initial physiotherapy versus midurethral-sling surgery for stress urinary incontinence.
• To evaluate subjective and objective cure rates at 12 months post-treatment.

Main Methods:

• A multicenter randomized trial involving 460 women with stress urinary incontinence.
• Participants were assigned to either physiotherapy or midurethral-sling surgery groups.
• Crossover to the alternative treatment was permitted; primary outcome was subjective improvement.

Main Results:

• Initial surgery resulted in significantly higher subjective improvement (90.8%) compared to physiotherapy (64.4%).
• Subjective cure rates were 85.2% for surgery versus 53.4% for physiotherapy.
• Objective cure rates were also higher with surgery (76.5%) than physiotherapy (58.8%).
• A high crossover rate was observed, with 49.0% of the physiotherapy group switching to surgery.

Conclusions:

• Initial midurethral-sling surgery is more effective than initial physiotherapy for treating stress urinary incontinence.
• Surgery leads to superior subjective and objective cure rates at one year.
• These findings support considering surgery as an initial treatment option.