Podcast: Keyhole (laparoscopic) surgery through the abdomen for treating urinary incontinence in women

Cochrane Incontinence has produced more than 40 systematic reviews of interventions that might help people suffering from incontinence. In this podcast, one of the group’s researchers, Fiona Stewart, talks with author Wael Agur, a subspecialist and lead urogynaecologist for NHS Ayrshire & Arran, UK, about the December 2019 update for one of these, looking at the effects of a type of surgery called laparoscopic colposuspension.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Cochrane Incontinence has produced more than 40 systematic reviews of interventions that might help people suffering from incontinence. In this podcast, one of the group’s researchers, Fiona Stewart, talks with author Wael Agur, a subspecialist and lead urogynaecologist for NHS Ayrshire & Arran, UK, about the December 2019 update for one of these, looking at the effects of a type of surgery called laparoscopic colposuspension.

Fiona: Hello Wael, first of all, could you tell us in one or two sentences about this surgery. What is it and what does it do?

Wael: Laparoscopic colposuspension is a keyhole surgery to the abdomen to stop urine leakage on coughing or exercise. Some people call it the ‘hitch and stitch’, as the vagina is suspended by stitches to supports the bladder neck.

Fiona: So why is it important to have a review of its effectiveness for urinary incontinence in women?

Wael: Incontinence is very common in women and the pelvic floor exercises are usually successful, but some women will still require surgery. Currently, there are concerns about the use of mesh in this area.  As a result, more women and surgeons are exploring the natural tissue surgery that is still minimally invasive such as laparoscopic colposuspension. We set out to update the scientific evidence for this surgical procedure to support women and surgeons in making an informed decision.

Fiona: Did you find the evidence you needed, and what does it say about laparoscopic colposuspension for treating incontinence?

Wael: On exploring the available evidence, our main interest was patient-reported cure of incontinence at 18 months following surgery. We identified 26 clinical trials involving nearly 2300 women. Some trials compared laparoscopic colposuspension to the traditional open approach while other trials compared laparoscopic colposuspension to the midurethral mesh sling procedures, the hammock that supports the bladder neck.

Fiona: And, what do these trials tell us?

Wael: Laparoscopic colposuspension using stitches, not mesh, is as good for curing incontinence as the traditional open approach. We were, however, less sure about the comparison to midurethral mesh sling operations. The previous version of this Cochrane Review in 2006 had suggested some advantage of the midurethral mesh tape option; but, in our updated review, we did not find such advantage. Therefore, for curing stress urinary incontinence in women, there may be little or no difference between the mesh option and laparoscopic colposuspension.

Fiona: What about the safety aspect? What evidence did you find about complications and adverse events among women having the surgery?

Wael: We found a possibility of a lower risk of surgical complications with the laparoscopic approach compared to the traditional open approach. For other adverse events, the risks were either likely to be similar or the evidence was too uncertain to come to a firm conclusion.

Fiona: Overall, what’s your take-home message about laparoscopic colposuspension?

Wael: Despite the limitations with the current evidence, laparoscopic colposuspension using sutures as a ‘class of procedures’ is generally safe and effective. It’s a first-line and minimally-invasive surgical alternative to be considered by women with stress urinary incontinence. It does not involve the use of a mesh device and, therefore, is a valid option for women concerned about mesh-related adverse events.

Fiona: Thanks Joe. If people would like to read the review, how can they get hold of it?

Wael: It’s available online – just go to www dot Cochrane Library dot com and type “laparoscopic colposuspension” in the search box. You will see our review near the top of the list.

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