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Surgery Better Than Physical Therapy for Incontinence

Findings based on patient-based reports of subjective improvement, cure

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WEDNESDAY, Sept. 18 (HealthDay News) -- Midurethral-sling surgery is more effective than physical therapy based on subjective reports of improvement from women with stress urinary incontinence, according to a study published in the Sept. 19 issue of the New England Journal of Medicine.

Julien Labrie, M.D., from the University Medical Center Utrecht in the Netherlands, and colleagues randomly assigned 230 women with stress urinary incontinence to midurethral-sling surgery and 230 women to physical therapy. Nearly half of the women in the physical therapy group (49 percent) and 11.2 percent of women in the surgery group crossed over to the alternative treatment. Subjective improvement was measured at 12 months with the Patient Global Impression of Improvement.

The researchers found that subjective improvement was reported by 90.8 percent of women in the surgery group and 64.4 percent of women in the physical therapy group, while 85.2 and 53.4 percent, respectively, reported subjective cure. Rates of objective cure were 76.5 and 58.8 percent, respectively. Women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery, and both these groups had outcomes superior to those of women who did not cross over to surgery, according to post hoc analysis.

"For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial [physical therapy], results in higher rates of subjective improvement and subjective and objective cure at one year," the authors write.

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