Anterior vaginal repair for urinary incontinence in women.

backgroundAnterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence.

objectivesTo determine the effects of anterior vaginal repair (anterior colporrhaphy) on stress or mixed urinary incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group's trials register, and the reference lists of relevant articles. Date of most recent search: March 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trial quality. One trial investigator was contacted for additional information. MAIN

resultsFive trials were identified which included 208 women having an anterior vaginal repair and 400 who received comparison interventions. A single small trial provided insufficient evidence to assess anterior repair in comparison with physical therapy. The performance of anterior repair in comparison with needle suspension appeared similar but clinically important differences could not be confidently ruled out. No trials compared anterior repair with sling or laparoscopic interventions, or compared alternative vaginal operations. Anterior repair was less effective than abdominal retropubic suspension based on patient-reported cure rates in four trials both in the short-term (failure rate within first year after anterior repair 48/198, 24% vs 30/266, 11%; RR 2.15, 95% CI 1.4 to 3.28) and long-term (80/193, 41% vs 51/261, 20%; RR 2.25, 95% CI 1.66 to 3.04). There was some evidence from one of these trials that this was reflected in fewer repeat operations for incontinence. These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although later prolapse operation appeared to be equally common after vaginal or abdominal operation there were too few data to judge this reliably. In respect of the type of abdominal retropubic suspension, most data related to comparisons of anterior repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension. REVIEWER'S

conclusionsThere were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in four trials, even in women who had prolapse in addition to stress incontinence. The need for repeat incontinence surgery also appeared less after the abdominal operation, but this was only reported in one small trial. However, there was not enough information about post-operative complications and morbidity.