Comparison of Surgical Procedures to Reduce Urinary Stress Incontinence

NCT ID: NCT00064662

Last Updated: 2013-05-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2/PHASE3
• Total Enrollment: 655 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2002-02-28
• Study Completion Date: 2010-03-31

Brief Summary

The primary aim of this clinical trial is to compare the treatment success for two surgical procedures that are frequently used and have similar cure rates, yet have not been compared directly to each other in a large, rigorously conducted randomized trial. The secondary aims of the trial are to compare other outcomes for the two surgical procedures, including quality of life, sexual function, satisfaction with treatment outcomes, complications, and need for other treatment(s)after surgery. Follow-up will be a minimum of two years and up to four years.

Conditions

Urinary Incontinence

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Burch

The Burch colposuspension

Group Type: OTHER

Burch Modified Tanagho

Intervention Type: PROCEDURE

The Burch colposuspension is a well-established procedure for surgically treating women with stress urinary incontinence. The Burch modified colposuspension suspends the anterior vaginal wall (at the level of the bladder neck) with permanent sutures tied to the iliopectineal ligament.

Sling

Pubovaginal sling, using autologous rectus fascia

Group Type: OTHER

Autologous Fascia Sling

Intervention Type: PROCEDURE

The fascial sling is also a well-established procedure for surgically treating women with stress urinary incontinence. The autologous sling procedure places a harvested strip of rectus fascia transvaginally at the level of the proximal urethra. The fascial strip is secured superiorly to the rectus fascia with permanent sutures

Interventions

Burch Modified Tanagho

The Burch colposuspension is a well-established procedure for surgically treating women with stress urinary incontinence. The Burch modified colposuspension suspends the anterior vaginal wall (at the level of the bladder neck) with permanent sutures tied to the iliopectineal ligament.

Intervention Type: PROCEDURE

Autologous Fascia Sling

The fascial sling is also a well-established procedure for surgically treating women with stress urinary incontinence. The autologous sling procedure places a harvested strip of rectus fascia transvaginally at the level of the proximal urethra. The fascial strip is secured superiorly to the rectus fascia with permanent sutures

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Ambulatory;
• Not pregnant;
• >12 months post-partum;
• No systemic disease known to affect bladder function;
• No current chemotherapy or radiation therapy;
• No urethral diverticulum, augmentation cytoplasty, or artificial sphincter;
• No recent pelvic surgery;
• Available for follow-up and able to complete study assessments;
• Signed informed consent.

• Minimum Eligible Age: 21 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

University of Alabama at Birmingham

OTHER

Sponsor Role: collaborator

University of California, San Diego

OTHER

Sponsor Role: collaborator

University of Maryland

OTHER

Sponsor Role: collaborator

University of Pittsburgh

OTHER

Sponsor Role: collaborator

University of Texas

OTHER

Sponsor Role: collaborator

The University of Texas at San Antonio

OTHER

Sponsor Role: collaborator

University of Utah

OTHER

Sponsor Role: collaborator

Beaumont Hospital

OTHER

Sponsor Role: collaborator

Loyola University

OTHER

Sponsor Role: collaborator

Carelon Research

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

William D. Steers, M.D.

Role: STUDY_CHAIR

University of Virginia

Locations

University of Alabama

Birmingham, Alabama, United States

University of California

San Diego, California, United States

Loyola University Medical Center

Maywood, Illinois, United States

University of Maryland

Baltimore, Maryland, United States

Beaumont Hospital

Royal Oak, Michigan, United States

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

University of Texas, Southwestern

Dallas, Texas, United States

University of Texas Health Sciences Center

San Antonio, Texas, United States

University of Utah

Salt Lake City, Utah, United States

Countries

United States

References

Albo M, Wruck L, Baker J, Brubaker L, Chai T, Dandreo KJ, Diokno A, Goode P, Kraus S, Kusek JW, Lemack G, Lowder J, Steers W; Urinary Incontinence Treatment Network. The relationships among measures of incontinence severity in women undergoing surgery for stress urinary incontinence. J Urol. 2007 May;177(5):1810-4. doi: 10.1016/j.juro.2007.01.032.

Reference Type: BACKGROUND

PMID: 17437826 (View on PubMed)

Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, Chai TC, Zyczynski H, Diokno AC, Tennstedt S, Nager C, Lloyd LK, FitzGerald M, Lemack GE, Johnson HW, Leng W, Mallett V, Stoddard AM, Menefee S, Varner RE, Kenton K, Moalli P, Sirls L, Dandreo KJ, Kusek JW, Nyberg LM, Steers W; Urinary Incontinence Treatment Network. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007 May 24;356(21):2143-55. doi: 10.1056/NEJMoa070416. Epub 2007 May 21.

Reference Type: BACKGROUND

PMID: 17517855 (View on PubMed)

Brubaker L, Chiang S, Zyczynski H, Norton P, Kalinoski DL, Stoddard A, Kusek JW, Steers W; Urinary Incontinence Treatment Network. The impact of stress incontinence surgery on female sexual function. Am J Obstet Gynecol. 2009 May;200(5):562.e1-7. doi: 10.1016/j.ajog.2008.11.017. Epub 2009 Mar 16.

Reference Type: BACKGROUND

PMID: 19286143 (View on PubMed)

Brubaker L, Stoddard A, Richter H, Zimmern P, Moalli P, Kraus SR, Norton P, Lukacz E, Sirls L, Johnson H; Urinary Incontinence Treatment Network. Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009;28(4):268-73. doi: 10.1002/nau.20698.

Reference Type: BACKGROUND

PMID: 19274758 (View on PubMed)

Burgio KL, Brubaker L, Richter HE, Wai CY, Litman HJ, France DB, Menefee SA, Sirls LT, Kraus SR, Johnson HW, Tennstedt SL. Patient satisfaction with stress incontinence surgery. Neurourol Urodyn. 2010 Nov;29(8):1403-9. doi: 10.1002/nau.20877.

Reference Type: BACKGROUND

PMID: 20976815 (View on PubMed)

Chai TC, Albo ME, Richter HE, Norton PA, Dandreo KJ, Kenton K, Lowder JL, Stoddard AM; Urinary Incontinence Treatment Network. Complications in women undergoing Burch colposuspension versus autologous rectus fascial sling for stress urinary incontinence. J Urol. 2009 May;181(5):2192-7. doi: 10.1016/j.juro.2009.01.019. Epub 2009 Mar 17.

Reference Type: BACKGROUND

PMID: 19296969 (View on PubMed)

FitzGerald MP, Burgio KL, Borello-France DF, Menefee SA, Schaffer J, Kraus S, Mallett VT, Xu Y; Urinary Incontinence Treatment Network. Pelvic-floor strength in women with incontinence as assessed by the brink scale. Phys Ther. 2007 Oct;87(10):1316-24. doi: 10.2522/ptj.20060073. Epub 2007 Aug 7.

Reference Type: BACKGROUND

PMID: 17684087 (View on PubMed)

Kenton K, Richter H, Litman H, Lukacz E, Leng W, Lemack G, Chai T, Arisco A, Tennstedt S, Steers W; Urinary Incontinence Treatment Network. Risk factors associated with urge incontinence after continence surgery. J Urol. 2009 Dec;182(6):2805-9. doi: 10.1016/j.juro.2009.08.032. Epub 2009 Oct 17.

Reference Type: BACKGROUND

PMID: 19837421 (View on PubMed)

Kirby AC, Nager CW, Litman HJ, FitzGerald MP, Kraus S, Norton P, Sirls L, Rickey L, Wilson T, Dandreo KJ, Shepherd JP, Zimmern P; Urinary Incontinence Treatment Network. Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes. Int Urogynecol J. 2011 Jun;22(6):657-63. doi: 10.1007/s00192-010-1336-5. Epub 2010 Dec 10.

Reference Type: BACKGROUND

PMID: 21153471 (View on PubMed)

Kraus SR, Markland A, Chai TC, Stoddard A, FitzGerald MP, Leng W, Mallett V, Tennstedt SL; Urinary Incontinence Treatment Network. Race and ethnicity do not contribute to differences in preoperative urinary incontinence severity or symptom bother in women who undergo stress incontinence surgery. Am J Obstet Gynecol. 2007 Jul;197(1):92.e1-6. doi: 10.1016/j.ajog.2007.03.072.

Reference Type: BACKGROUND

PMID: 17618773 (View on PubMed)

Lemack GE, Krauss S, Litman H, FitzGerald MP, Chai T, Nager C, Sirls L, Zyczynski H, Baker J, Lloyd K, Steers WD; Urinary Incontinence Treatment Network. Normal preoperative urodynamic testing does not predict voiding dysfunction after Burch colposuspension versus pubovaginal sling. J Urol. 2008 Nov;180(5):2076-80. doi: 10.1016/j.juro.2008.07.027. Epub 2008 Sep 18.

Reference Type: BACKGROUND

PMID: 18804239 (View on PubMed)

Lemack GE, Xu Y, Brubaker L, Nager C, Chai T, Moalli P, Kraus SR, Kerr L, Sirls L, Stoddard A; Urinary Incontinence Treatment Network. Clinical and demographic factors associated with valsalva leak point pressure among women undergoing burch bladder neck suspension or autologous rectus fascial sling procedures. Neurourol Urodyn. 2007;26(3):392-6. doi: 10.1002/nau.20325.

Reference Type: BACKGROUND

PMID: 17304525 (View on PubMed)

Mallett VT, Brubaker L, Stoddard AM, Borello-France D, Tennstedt S, Hall L, Hammontree L; Urinary Incontinence Treatment Network. The expectations of patients who undergo surgery for stress incontinence. Am J Obstet Gynecol. 2008 Mar;198(3):308.e1-6. doi: 10.1016/j.ajog.2007.09.003.

Reference Type: BACKGROUND

PMID: 18313452 (View on PubMed)

Markland AD, Kraus SR, Richter HE, Nager CW, Kenton K, Kerr L, Xu Y; Urinary Incontinence Treatment Network. Prevalence and risk factors of fecal incontinence in women undergoing stress incontinence surgery. Am J Obstet Gynecol. 2007 Dec;197(6):662.e1-7. doi: 10.1016/j.ajog.2007.08.062.

Reference Type: BACKGROUND

PMID: 18060972 (View on PubMed)

Nager CW, Albo ME, Fitzgerald MP, McDermott S, Wruck L, Kraus S, Howden N, Norton P, Sirls L, Varner E, Zimmern P; Urinary Incontinence Treatment Network. Reference urodynamic values for stress incontinent women. Neurourol Urodyn. 2007;26(3):333-40. doi: 10.1002/nau.20348.

Reference Type: BACKGROUND

PMID: 17315221 (View on PubMed)

Nager CW, Albo ME, Fitzgerald MP, McDermott SM, Kraus S, Richter HE, Zimmern P; Urinary Incontinence Treatment Network. Process for development of multicenter urodynamic studies. Urology. 2007 Jan;69(1):63-7; discussion 67-8. doi: 10.1016/j.urology.2006.08.1118.

Reference Type: BACKGROUND

PMID: 17270617 (View on PubMed)

Nager CW, FitzGerald M, Kraus SR, Chai TC, Zyczynski H, Sirls L, Lemack GE, Lloyd LK, Litman HJ, Stoddard AM, Baker J, Steers W; Urinary Incontinence Treatment Network. Urodynamic measures do not predict stress continence outcomes after surgery for stress urinary incontinence in selected women. J Urol. 2008 Apr;179(4):1470-4. doi: 10.1016/j.juro.2007.11.077. Epub 2008 Mar 4.

Reference Type: BACKGROUND

PMID: 18295276 (View on PubMed)

Richter HE, Burgio KL, Brubaker L, Moalli PA, Markland AD, Mallet V, Menefee SA, Johnson HW, Boreham MK, Dandreo KJ, Stoddard AM; Urinary Incontinence Treatment Network. Factors associated with incontinence frequency in a surgical cohort of stress incontinent women. Am J Obstet Gynecol. 2005 Dec;193(6):2088-93. doi: 10.1016/j.ajog.2005.07.068.

Reference Type: BACKGROUND

PMID: 16325621 (View on PubMed)

Richter HE, Diokno A, Kenton K, Norton P, Albo M, Kraus S, Moalli P, Chai TC, Zimmern P, Litman H, Tennstedt S; Urinary Incontinence Treatment Network. Predictors of treatment failure 24 months after surgery for stress urinary incontinence. J Urol. 2008 Mar;179(3):1024-30. doi: 10.1016/j.juro.2007.10.074. Epub 2008 Jan 18.

Reference Type: BACKGROUND

PMID: 18206917 (View on PubMed)

Richter HE, Goode PS, Brubaker L, Zyczynski H, Stoddard AM, Dandreo KJ, Norton PA. Two-year outcomes after surgery for stress urinary incontinence in older compared with younger women. Obstet Gynecol. 2008 Sep;112(3):621-9. doi: 10.1097/AOG.0b013e31818187c2.

Reference Type: BACKGROUND

PMID: 18757661 (View on PubMed)

Sanses TV, Brubaker L, Xu Y, Kraus SR, Lowder JL, Lemack GE, Norton P, Litman HJ, Tennstedt SL, Chai TC. Preoperative hesitating urinary stream is associated with postoperative voiding dysfunction and surgical failure following Burch colposuspension or pubovaginal rectus fascial sling surgery. Int Urogynecol J. 2011 Jun;22(6):713-9. doi: 10.1007/s00192-010-1328-5. Epub 2010 Dec 3.

Reference Type: BACKGROUND

PMID: 21128068 (View on PubMed)

Steers W, Richter H, Nyberg L, Kusek J, Kraus S, Dandreo K, Chai T, Brubaker L. Challenges of conducting multi-center, multi-disciplinary urinary incontinence clinical trials: experience of the urinary incontinence treatment network. Neurourol Urodyn. 2009;28(3):170-6. doi: 10.1002/nau.20653.

Reference Type: BACKGROUND

PMID: 19030190 (View on PubMed)

Subak LL, Brubaker L, Chai TC, Creasman JM, Diokno AC, Goode PS, Kraus SR, Kusek JW, Leng WW, Lukacz ES, Norton P, Tennstedt S; Urinary Incontinence Treatment Network. High costs of urinary incontinence among women electing surgery to treat stress incontinence. Obstet Gynecol. 2008 Apr;111(4):899-907. doi: 10.1097/AOG.0b013e31816a1e12.

Reference Type: BACKGROUND

PMID: 18378749 (View on PubMed)

Tennstedt S; Urinary Incontinence Treatment Network. Design of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr). Urology. 2005 Dec;66(6):1213-7. doi: 10.1016/j.urology.2005.06.089.

Reference Type: BACKGROUND

PMID: 16360445 (View on PubMed)

Tennstedt SL, Fitzgerald MP, Nager CW, Xu Y, Zimmern P, Kraus S, Goode PS, Kusek JW, Borello-France D, Mallett V; Urinary Incontinence Treatment Network. Quality of life in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007 May;18(5):543-9. doi: 10.1007/s00192-006-0188-5. Epub 2006 Oct 12.

Reference Type: BACKGROUND

PMID: 17036169 (View on PubMed)

Tennstedt SL, Litman HJ, Zimmern P, Ghetti C, Kusek JW, Nager CW, Mueller ER, Kraus SR, Varner E; Urinary Incontinence Treatment Network. Quality of life after surgery for stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Dec;19(12):1631-8. doi: 10.1007/s00192-008-0700-1. Epub 2008 Aug 6.

Reference Type: BACKGROUND

PMID: 18682875 (View on PubMed)

Walsh LP, Zimmern PE, Pope N, Shariat SF; Urinary Incontinence Treatment Network. Comparison of the Q-tip test and voiding cystourethrogram to assess urethral hypermobility among women enrolled in a randomized clinical trial of surgery for stress urinary incontinence. J Urol. 2006 Aug;176(2):646-9; discussion 650. doi: 10.1016/j.juro.2006.03.091.

Reference Type: BACKGROUND

PMID: 16813912 (View on PubMed)

Zimmern P, Nager CW, Albo M, Fitzgerald MP, McDermott S; Urinary Incontinence Treatment Network. Interrater reliability of filling cystometrogram interpretation in a multicenter study. J Urol. 2006 Jun;175(6):2174-7. doi: 10.1016/S0022-5347(06)00343-0.

Reference Type: BACKGROUND

PMID: 16697832 (View on PubMed)

Zyczynski HM, Lloyd LK, Kenton K, Menefee S, Boreham M, Stoddard AM; Urinary Incontinence Treatment Network (UITN). Correlation of Q-tip values and point Aa in stress-incontinent women. Obstet Gynecol. 2007 Jul;110(1):39-43. doi: 10.1097/01.AOG.0000267190.09976.81.

Reference Type: BACKGROUND

PMID: 17601894 (View on PubMed)

Kraus SR, Lemack GE, Sirls LT, Chai TC, Brubaker L, Albo M, Leng WW, Lloyd LK, Norton P, Litman HJ; Urinary Incontinence Treatment Network. Urodynamic changes associated with successful stress urinary incontinence surgery: is a little tension a good thing? Urology. 2011 Dec;78(6):1257-62. doi: 10.1016/j.urology.2011.07.1413. Epub 2011 Oct 11.

Reference Type: BACKGROUND

PMID: 21996108 (View on PubMed)

Kraus SR, Lemack GE, Richter HE, Brubaker L, Chai TC, Albo ME, Sirls LT, Leng WW, Kusek JW, Norton P, Litman HJ; Urinary Incontinence Treatment Network. Changes in urodynamic measures two years after Burch colposuspension or autologous sling surgery. Urology. 2011 Dec;78(6):1263-8. doi: 10.1016/j.urology.2011.07.1411. Epub 2011 Oct 11.

Reference Type: BACKGROUND

PMID: 21996105 (View on PubMed)

Zimmern PE, Dandreo KJ, Sirls L, Howell A, Hall L, Gruss J, Jesse K, Dickinson T, Prather C. Lessons from a patient experience survey in a randomized surgical trial of treatment of stress urinary incontinence in women. Int Urogynecol J. 2011 Oct;22(10):1273-8. doi: 10.1007/s00192-011-1507-z. Epub 2011 Jul 26.

Reference Type: BACKGROUND

PMID: 21789658 (View on PubMed)

Kirby AC, Nager CW, Litman HJ, Fitzgerald MP, Kraus S, Norton P, Sirls L, Rickey L, Wilson T, Dandreo KJ, Shepherd J, Zimmern P; Urinary Incontinence Treatment Network. Perineal surface electromyography does not typically demonstrate expected relaxation during normal voiding. Neurourol Urodyn. 2011 Nov;30(8):1591-6. doi: 10.1002/nau.21080. Epub 2011 May 10.

Reference Type: BACKGROUND

PMID: 21560157 (View on PubMed)

Brubaker L, Litman HJ, Kim HY, Zimmern P, Dyer K, Kusek JW, Richter HE, Stoddard A; Urinary Incontinence Treatment Network. Missing data frequency and correlates in two randomized surgical trials for urinary incontinence in women. Int Urogynecol J. 2015 Aug;26(8):1155-9. doi: 10.1007/s00192-015-2661-5. Epub 2015 Mar 24.

Reference Type: DERIVED

PMID: 25800900 (View on PubMed)

Richter HE, Brubaker L, Stoddard AM, Xu Y, Zyczynski HM, Norton P, Sirls LT, Kraus SR, Chai TC, Zimmern P, Gormley EA, Kusek JW, Albo ME; Urinary Incontinence Treatment Network. Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries. J Urol. 2012 Aug;188(2):485-9. doi: 10.1016/j.juro.2012.04.010. Epub 2012 Jun 15.

Reference Type: DERIVED

PMID: 22704099 (View on PubMed)

Brubaker L, Richter HE, Norton PA, Albo M, Zyczynski HM, Chai TC, Zimmern P, Kraus S, Sirls L, Kusek JW, Stoddard A, Tennstedt S, Gormley EA; Urinary Incontinence Treatment Network. 5-year continence rates, satisfaction and adverse events of burch urethropexy and fascial sling surgery for urinary incontinence. J Urol. 2012 Apr;187(4):1324-30. doi: 10.1016/j.juro.2011.11.087. Epub 2012 Feb 15.

Reference Type: DERIVED

PMID: 22341290 (View on PubMed)

Brubaker L, Rickey L, Xu Y, Markland A, Lemack G, Ghetti C, Kahn MA, Nagaraju P, Norton P, Chang TD, Stoddard A; Urinary Incontinence Treatment Network. Symptoms of combined prolapse and urinary incontinence in large surgical cohorts. Obstet Gynecol. 2010 Feb;115(2 Pt 1):310-316. doi: 10.1097/AOG.0b013e3181cb86b2.

Reference Type: DERIVED

PMID: 20093904 (View on PubMed)

Brubaker L, Moalli P, Richter HE, Albo M, Sirls L, Chai T, Kraus SR, Norton P, Chang D, Tennstedt SL. Challenges in designing a pragmatic clinical trial: the mixed incontinence -- medical or surgical approach (MIMOSA) trial experience. Clin Trials. 2009 Aug;6(4):355-64. doi: 10.1177/1740774509339239. Epub 2009 Jul 22.

Reference Type: DERIVED

PMID: 19625327 (View on PubMed)

Richter HE, Burgio KL, Chai TC, Kraus SR, Xu Y, Nyberg L, Brubaker L. Predictors of outcomes in the treatment of urge urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May;20(5):489-97. doi: 10.1007/s00192-009-0805-1. Epub 2009 Jan 30.

Reference Type: DERIVED

PMID: 19183825 (View on PubMed)

Related Links

http://www.uitn.net

www.uitn.net

Other Identifiers

UITN-RCT (completed)

Identifier Type: -

Identifier Source: org_study_id