TY - JOUR
T1 - Twelve-Year Follow-Up of a Randomised Controlled Trial Comparing the Effectiveness of Pelvic Floor Muscle Training Versus Mid-Urethral Sling Surgery for Female Moderate to Severe Urinary Incontinence
AU - van Oorschot, Hélène F C
AU - Tijsseling, Deodata
AU - Labrie, Julien
AU - van der Vaart, Carl H
N1 - Publisher Copyright:
© 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2025/5
Y1 - 2025/5
N2 - OBJECTIVE: To compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.DESIGN: Observational follow-up study of a randomised controlled trial.SETTING: Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.POPULATION: Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.METHODS: A validated questionnaire was sent to participants.MAIN OUTCOME MEASURES: The primary outcome was subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.RESULTS: In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2-73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8-73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.CONCLUSION: This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic floor muscle physiotherapy only in the long-term.
AB - OBJECTIVE: To compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.DESIGN: Observational follow-up study of a randomised controlled trial.SETTING: Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.POPULATION: Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.METHODS: A validated questionnaire was sent to participants.MAIN OUTCOME MEASURES: The primary outcome was subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.RESULTS: In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2-73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8-73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.CONCLUSION: This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic floor muscle physiotherapy only in the long-term.
KW - PORTRET
KW - follow-up
KW - improvement
KW - midurethral sling surgery
KW - pelvic floor muscle therapy
KW - physiotherapy
KW - randomised controlled trial
KW - surgery
KW - tension free vaginal tape
KW - urinary incontinence
UR - http://www.scopus.com/inward/record.url?scp=85218845881&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.18092
DO - 10.1111/1471-0528.18092
M3 - Article
C2 - 39931871
SN - 1470-0328
VL - 132
SP - 826
EP - 833
JO - BJOG - An International Journal of Obstetrics and Gynaecology
JF - BJOG - An International Journal of Obstetrics and Gynaecology
IS - 6
ER -