Impact of surgery for stress incontinence on morbidity

BMJ 1998;317:143 ( 11 July )

Letters

Impact of surgery for stress incontinence on morbidity

Effects of confounding variables on outcomes of incontinence surgery must be considered

Patients should be told hospital results and allowed to choose where they want surgery

Treatment needs to be based on objective assessment rather than on symptoms

Colposuspension has highest cure rates

Pragmatic randomised trial is required

Authors' reply

Effects of confounding variables on outcomes of incontinence surgery must be considered

The first 150 words of the full text of this article appear below.

EDITOR $---$ Black et al's study highlighted difficulties that those who assess the treatment of urinary incontinence may encounter.¹The different surgical procedures were considered together, whichmakes it impossible to interpret cure rates or postoperative morbidity.Previous continence surgery was not reported, although this affectsthe results of surgery.

Black et al state that calculations of sample size were inappropriate as the objective was to provide preliminary estimatesof variables and to generate hypotheses. They found no significantdifference in outcome between women who had preoperative urodynamictesting and women who did not. On the basis of the objective curerates reported in the literature, ² ³ however, two groupsof 220 women would be needed to show that urodynamics does notmake a difference to the outcome of surgery, assuming a powerof 0.90 and a significance level of 0.05.⁴ Black et al's studyis too small to show this and does . . . [Full text of this article]

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