Three surgical procedures for genuine stress incontinence: five-year follow-up of a prospective randomized study

Our purpose was to evaluate and compare the long-term results of the Kelly plication, modified Pereyra needle suspension, and Burch urethropexy for the treatment of stress urinary incontinence in women.

One hundred twenty-seven consecutive women underwent surgery at the gynecologic urology division at Women's Hospital, Los Angeles County-University of Southern California Medical Center between January 1986 and June 1987. The only indication for surgery was stress urinary incontinence. Women with previously failed antiincontinence procedures were excluded. Fifty-three patients were premenopausal and 74 postmenopausal. History, physical examination, urethocystoscopy, cotton swab test, filling cystometry, urethral pressure profile at rest and on cough, and uroflowmetry were performed preoperatively, 3 months, 1 year, and 5 years postoperatively. The subjects and surgeons were randomly allocated to one of three surgical procedures: group 1 had anterior colporrhaphy with Kelly plication, group 2 had modified Pereyra needle urethropexy, and group 3 had Burch urethropexy. One hundred seven women were available after 1 year, and 93 were the subjects of the 5-year evaluation. Fisher exact text, chi 2, t test, and paired t test were used for statistical analysis.

The results of the 1-year postoperative evaluation has been previously published. The objective success rate for groups 1, 2, and 3 after 5 years was 37%, 43%, and 82%, respectively, and the difference was statistically significant. The drop in the success rate in 4 years was 26%, 22%, and 7% for groups 1, 2, and 3, respectively. Urodynamically all three procedures significantly increased the abdominal pressure transmission to the urethra, when successful. Ninety-one percent of women after the Burch procedure had a negative cotton swab test after 5 years compared with 46% for the Pereyra and 30% for the Kelly procedures.

In our hands the Burch urethropexy has a higher cure rate that holds over time when compared with the modified Pereyra needle suspension and the Kelly plication. The lower incidence of the positive cotton swab test in women after Burch urethropexy may be proof of a better anatomic suspension of the bladder neck.