Exercise or Surgery? There is no easy option. Your pelvic floor is weak, but pelvic floor professionals can help you avoid the knife, and heres why you have to make those physiotherapy sessions work! PELVIC FLOOR MUSCLE TRAINING VERSUS RETROPUBIC MIDURETHRAL SLING AS THE INITIAL TREATMENT FOR STRESS URINARY INCONTINENCE: A DECISION ANALYSIS R. POSTHUMA, S. J. PULLIAM, C. E. FOUST-WRIGHT, M. M. WEINSTEIN, M. M. WAKAMATSU, A. J. KAIMAL; Massachusetts Gen. Hosp., Boston, MA. Int Urogyn Journal 2014 Introduction: Stress urinary incontinence (SUI) is a common condition affecting up to 30 % of women that has significant economic impact on the individual and on the healthcare system [1]. The direct out-of-pocket cost of SUI is estimated at $750 per woman per year and the total directs costs associated with urinary incontinence exceed $16 billion. In general, SUI can be managed conservatively, with pelvic floor muscle training (PFMT), or surgically. The most common surgical treatment for SUI is minimally invasive midurethral sling (MUS). Objective: To determine the cost-effectiveness of PFMT with a physical therapist versus MUS for initial treatment of SUI. We used decision analysis to compare the strategies of an initial course of PFMT followed by MUS if PFMT was ineffective, versus proceeding directly with MUS for the diagnosis of SUI. Methods: A decision-analytic model was developed to compare outcomes (cure of incontinence, surgical complications, need for second procedure, and development of urgency urinary incontinence) as well as cost-effectiveness of the two proposed strategies for the initial treatment of SUI. All women whose symptoms did not resolve with PFMT with a physical therapist were assumed to proceed with MUS. Baseline assumptions were derived from the literature and included an average age of presentation for treatment of 55 years, a 40 % cure rate with PFMT, a 78 % cure rate with midurethral sling, and an 80 % likelihood of proceeding with a second sling procedure if the first was not effective [1,2,3]. Assumptions were based on retropubic midurethral sling data. Success rates, complication rates, costs, and the utility associated with incontinence outcomes were also derived from the literature [1,2,3]. Sensitivity analyses were performed to test the robustness of our findings. Results: A strategy of initial course of PFMT was dominant, meaning that it was more effective and less costly than proceeding directly with MUS at the time of presentation for treatment of SUI. An initial course of PFMT also resulted in the highest cure rate and the lowest complication rate. This result was robust to variation in all inputs, including the cost and effectiveness of PFMT as well as MUS. Conclusions: An initial course of PFMT prior to proceeding with MUS optimizes outcomes and decreases costs of cure in women with SUI. Along with patient preference, this information should be considered when contemplating the optimal initial strategy for treatment of women with stress urinary incontinence. (via MaryODwyer)
Posted on: Mon, 24 Nov 2014 10:58:07 +0000
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