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1. Experts reassure on controversial incontinence op

   Jul 1, 2015 | WebMD

   By Peter Russell
   
   
   Now, a new Cochrane systematic review has looked at 81 trials involving 12,113 women. These trials showed that over 80% of women with stress urinary incontinence are either cured or experience relief in their symptoms, with either operation, 5 years after surgery.

Client Attorney Privileged/Attorney Work Product/At Request of Counsel

Online Sources

1. Experts reassure on controversial incontinence op

   Jul 1, 2015 | WebMD

   By Peter Russell

   A common surgical procedure for urinary incontinencethat some women say has led to excruciating pain and discomfort is relatively safe and effective, say experts.

   Stress urinary incontinence is the name given to a condition in which a person accidentally passes urine, often as a result of coughing, sneezing or physical exertion.

   It is a common problem, particularly in women who have had children, and affects around 9 million people in the UK. A weak bladder usually occurs when the muscles in the pelvic floor or sphincter have been damaged or weakened.Supporting the bladder

   Although the main treatment for stress incontinence is pelvic floor exercises, surgery is sometimes recommended to support the bladder.

   The procedure involves one of two common operations to support the bladder. One approach is the insertion of a sling, made of an artificial mesh, behind the pubic bone coming out via the abdomen - known as the bottom-to-top 'retropubic' route - or alternatively from side-to-side coming out through the groin - called the 'transobturator' route.

   However, some women have complained that these implants have caused them severe pain and damaged their quality of life.Independent review

   Last year the Scottish health secretary called on the NHS in Scotland to suspend the use of these mesh medical devices until more evidence becomes available. An independent review set up in Scotland last year about the safety of these operations is due to report later this year.

   Last year, the Medicines and Healthcare products Regulatory Agency (MHRA) said it had received 291 reports of adverse effects related to mesh implants for stress urinary incontinence, with the number of cases reported increasing markedly in the previous 2 years.80% 'cure'

   Now, a new Cochrane systematic review has looked at 81 trials involving 12,113 women. These trials showed that over 80% of women with stress urinary incontinence are either cured or experience relief in their symptoms, with either operation, 5 years after surgery.

   The study found that passing the sling behind the pubic bone - the retropubic approach - seemed to carry a higher risk of damaging the bladder than the transobturator approach, but that the operation led to less groin pain in the short term.

   However, the authors stress that the quality of the evidence available to them was only moderate. Furthermore, there are uncertainties about what happens to patients in the longer term.'Consider alternatives'

   Lead author Abigail Ford from Bradford Teaching Hospitals says in a statement: "Understanding this evidence in context is really important for women. They need to be aware of less invasive alternatives such as pelvic floor exercises, which should be tried first before contemplating any type of surgery.

   "As all surgery carries some risk, women must weigh up carefully how much they are troubled by their urine leakage against taking a small chance that things may go wrong as a result of surgery."

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