Incontinence surgery is best for physiotherapy in trials

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Serena Gordon
Health Day Reporter

Wednesday, September 18 (HealthDay News)- stress Urinary incontinence. Is a common problem in women, and new studies suggest that surgery may be a better first-line treatment than strengthening the pelvic muscles.

In what was claimed as the first comparison of the two treatments, Dutch researchers found a type called mid-urethral sling surgery compared to 64% of women who received physiotherapy for pelvic floor muscle training. We found that almost 91% of women who had surgery reported improvement to fix the problem.

“Prevalence of stress urine incontinence -Physical leak exercise, Laughter, cough -High and can have a tremendous impact on everyday life, “said Dr. Julian Lovely, lead author of the study. Gynecology Lives in the Utrecht University Medical Center in the Netherlands.

“Regardless of severity incontinence, Pelvic floor muscle training is the first-line treatment for most international guidelines, “says Lovely. [midurethral-sling surgery] We thought it was time to compare surgery with pelvic floor muscle training as a first-line treatment for moderate to severe women because it was safe and lasting. stress Urinary incontinence... “

The survey results are published in the September 19th issue. New England Journal of Medicine..

stress According to the US Open, incontinence is a problem that affects many women as they get older and has a negative impact on their quality of life.

Treatment options include pelvic floor training. This includes an exercise called Kegel that helps strengthen the muscles of the pelvis. It is expected that stronger muscles can effectively close the urethra and suppress urine. According to the background information of the study, the subjective success rate varies greatly with pelvic floor muscle training, ranging from 53% to 97%.

There are also several surgical options. One is central urethral sling surgery. This is a minimally invasive surgery that involves inserting a hammock-like device under the urethra to provide additional support and compression to keep the urethra closed. Studies have reported that the subjective cure rate for this procedure varies from 75% to 94%.

To see how these options are compared, researchers recruited 230 women for pelvic floor training (physical therapy) and an additional 230 women for surgery. bottom. Researchers allowed both groups of women to switch if they were dissatisfied with their treatment.

Almost half of the women in the physiotherapy group switched to the surgery group, while 11% of the women in the surgery group switched to physiotherapy during the study.

A year later, researchers found that subjective improvements were reported by 90.8 percent of women in the surgery group and 64.4 percent in the physiotherapy group. The subjective cure rate was rather low, 85.2 percent in the surgery group and 53.4 percent in the physiotherapy group.

Surgical risks include perforation, the need for reoperation, postoperative bleeding, blood loss, and new urine. Promote incontinence, According to research.

“We feel that both surgery and physiotherapy should be offered as first-line treatment options,” Labrie said. “The woman herself needs to be involved in deciding what to treat in her individual case.”

However, Labrie said the study did not include women with mild incontinence and the results should not be applied to women with mild stress incontinence.

Dr. Benjamin Brooker, an assistant professor of female pelvic medicine and reconstructive surgery at NYU Langone Medical Center in New York City, described the study as “very well designed.”

The data on surgical complications were encouraging, he said, as the complications were relatively minor.

But where do all of this leave women with urinary incontinence? Which option should they choose?

“Each woman is unique,” Bruker said. “What’s best for one woman isn’t for all others.”

“At the individual level, this study shows that if you want to be conservative, you won’t lose anything if you first get physiotherapy,” he said. “But it also hurt yourself by having surgery first if you’re a woman who says,’I want to put this behind me,’ depending on your embarrassment and emotional health score. It also shows that it is not. ”

Copyright © 2013 Health Day. all rights reserved.


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Source: Julien Labrie, MD, Gynecological Resident, Ph.D. Candidate, Utrecht University Medical Center, The Netherlands. Benjamin Brooker, MD, Assistant Professor, Women’s Pelvic Medicine and Reconstructive Surgery, Urology, NYU Langone Medical Center, New York City. September 19, 2013, New England Journal of Medicine

Incontinence surgery is best for physiotherapy in trials

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