Laparoscopic Burch Colposuspension Versus Transobturatory Tape for the Treatment of Female Urinary Stress Incontinence

Study Overview
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Brief Summary
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Transobturatory tape (TOT) procedure is a minimally invasive approach to urinary stress incontinence owing to the category of the sling-adopting procedures. Its efficacy and safety, also in comparison with similar procedures have been demonstrated. The benefits of the sling- adopting procedures in comparison to laparoscopic Burch colposuspension, which has been considered as the gold standard treatment, have been showed. But these comparisons did not included the TOT procedure in the experimental arms. Based on this considerations the aim of this trial will be to compare TOT and laparoscopic Burch colposuspension in women with urinary stress incontinence.

Detailed Description
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Women with predominant and genuine stress urinary incontinence will be enrolled and randomized in two groups (groups A and B). Patients of group A will be treated with laparoscopic Burch colposuspension, whereas patients of group B will be treated with TOT procedure. All patients eligible will undergo baseline assessment consisting of anthropometric, clinical, hormonal, urodynamic, and ultrasonographic evaluations. During the study, the surgical outcomes, the clinical subjective and objective efficacy data, and the adverse experiences will be evaluated in each patient. Data will be analyzed using the intention-to-treat principle and a P value of 0.05 or less will be considered significant.

Official Title
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A Comparison Between Laparoscopic Burch Colposuspension and Transobturatory Tape (TOT) for the Treatment of Female Urinary Stress Incontinence

Conditions
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Stress Urinary Incontinence

Intervention / Treatment
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* Procedure: Laparoscopic Burch colposuspension
* Procedure: Transobturator tape procedure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Predominant or genuine stress urinary incontinence by self report,examination and test Urethral hypermobility Eligible for both surgical procedures Ambulatory Exclusion Criteria: Pregnancy <12 months post-partum Systemic disease and/or drugs known to affect bladder function Current chemotherapy or radiation therapy Urethral diverticulum, augmentation cytoplasty, or artificial sphincter Recent pelvic surgery Severe genuine stress incontinence (loss of urine with minimal physical activity) with associated prolapse equal to or more than second degree Previous pelvic or anti-incontinence surgery History of severe abdominopelvic infections Known extensive abdominopelvic adhesions Detrusor instability and/or intrinsic sphincter dysfunction Other gynaecologic pathologies (eg, fibroids, ovarian cysts) BMI >30

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br> | Procedure: Laparoscopic Burch colposuspension<br>* Lapaparoscopic approach. One or two nonadsorbable sutures are placed at the level of the midurethra without penetrating the vaginal mucosa and fixed to Cooper's ligament with a tension free knotting technique.<br>|
| Experimental: Group B<br> | Procedure: Transobturator tape procedure<br>* Small incision sites in the vagina and in the femoral/pelvic fold. Bilateral transobturator insertion of mesh by means of needle. Application of resorbable tensioning suture that maintains the mesh and enables fine adjustments in mesh tension during the procedure and in the immediate postoperative period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective/subjective symptoms improvements |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intra-operative complication rate |  | one day | 
| Postoperative complications rate |  | 12 months | 
| Failure rate |  | 12 months | 
| Recurrence rate |  | 12 months | 
| Quality of life |  | 12 months | 
| Sexual function |  | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stress incontinence, Laparoscopic Burch colposuspension, Surgery, TOT, Treatment, Predominant or genuine stress urinary incontinence