Physiotherapy with pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence (SUI) in women, with midurethral-sling surgery generally recommended when physiotherapy is unsuccessful. New findings from a Dutch study, however, show that an initial surgical approach offers better outcomes.

In a study of 460 women with moderate-to-severe SUI, Julien Labrie, MD, of University Medical Centre Utrecht, the Netherlands, and colleagues found that midurethral-sling surgery resulted in higher rates of subjective improvement and subjective and objective cure at one year, according to findings published in the New England Journal of Medicine (2013;369:1124-1133).

Dr. Labrie’s group randomly assigned 230 women to undergo surgery and 230 to receive physiotherapy. The primary outcome measure was subjective improvement as measured using the Patient Global Impression of Improvement at 12 months.

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Forty-nine percent of women in the physiotherapy group and 11.2% of the surgery group crossed over the alternative treatment. Subjective improvement was by 90.8% of women in the surgery group compared with 64.4% of those in the physiotherapy group. The rates of subjective cure were 85.2% in the surgery group versus 53.4% in the physiotherapy group. The rates of objective cure were 76.5% and 58.8%, respectively.

The study also found that “women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery, and both of these groups had outcomes superior to those of women who did not cross over to surgery.”

“Our findings suggest that women with this condition should be counseled regarding both pelvic-floor muscle training and midurethral-sling surgery as initial treatment options,” the investigators concluded.