Four extra stitches can help prevent a lifetime of bladder problems in tens of thousands of women each year who have surgery to fix sagging internal organs, a new study suggests.
"It's a very common problem in women, and this is the first time we've been able to demonstrate that an operation can actually prevent urinary incontinence," said Dr. Linda Brubaker of Loyola University, who led the study. Results were published in Thursday's New England Journal of Medicine.
The nationwide, federally funded study was stopped early because the benefits were so clear.
It involved 322 women having surgery for uterine prolapse, a painful condition that occurs when the uterus weakens and sags into the birth canal. Frequent childbirth increases the chances of this happening, and about 200,000 women a year have surgery for it.
But the operation often leads to bladder control problems. Doctors wanted to see whether adding a second step, called the Burch procedure, could prevent this.
Stitches help support urinary muscle
The procedure involves placing four permanent stitches, two on either side, from the vagina to a pelvic ligament. The stitches form a hammock that keeps a urinary control muscle supported.
In the study, only 6 percent of women given the Burch procedure while having surgery for prolapse reported bothersome urinary control symptoms three months later, versus 25 percent of those who didn't have the additional procedure.
The technique is named for Dr. John Burch, a Tennessee obstetrician who pioneered it in the 1960s. It's already a common treatment for the type of bladder problem known as stress incontinence, when urinary leakage occurs during a cough or sneeze. There are other treatments for this condition as well, and this study was not designed to compare them.
Nor does it apply to every method for fixing prolapse, just one very common one.
Still, "this study provides solid data" to justify adding the Burch procedure with prolapse surgery, Dr. Rebecca Rogers, a gynecologist at the University of New Mexico, writes in an editorial in the journal. It also raises the bar for finding better solutions for these common women's health problems, she said.