; ; ;
Professor Wenderlein again points out the importance of local hormonal treatment in treating the overactive bladder. In our article, we referred to the effectiveness of local estrogen treatment, citing a current systematic review. Local application of estrogen has a firm place in the treatment of urinary incontinence.
Otto, Bagner, and Klosterhalfen in their contribution essentially articulate three statements.
- They criticize our statement, that tension-free slings are equally as effective as traditional methods, is not valid because the observational periods, of 2 years or less, were not long enough.
- They say that in our article, the indication for colposuspension applies to recurrences only.
- And, citing their own article in Deutsches Ärzteblatt, they point out problems associated with using alloplastic materials.
We wish to comment as follows.
- For tension-free slings, we wrote in our article: “Success rates over time are between 73% and 95% and are thus comparable with those associated with colposuspension; this has been shown in randomized controlled trials.” Among others, we cite 2 studies with follow-up periods of 5, or 4–8 years, respectively (1). Further studies with longer follow-up periods (up to 11.5 years) have been published, which have shown the high efficacy and safety of tension-free tape surgery (2, 3).
- We also mentioned the fact that open colposuspension is supported by a vast array of good data and listed different indications for the procedure; recurrence was only one of these. Other listed indications are: incontinence surgery in the context of laparotomy and in the context of abdominal descent surgery. Colposuspension can of course still be used primarily for the surgical treatment of stress incontinence, even if this is less common now thanks to the success of the tension-free slings.
- With regard to alloplastic materials, a distinction needs to be made between incontinence treatment and surgery for prolapse. In the latter, alloplastic meshes can now luckily be successfully deployed after recurrence. In primary surgery, tension-free slings have also proved successful. The tension-free tape (TVT) procedure is regarded as the greatest innovation in the treatment of stress incontinence. In this context, we would d like to mention correspondence by Dimpfl and Thunn, Watermann and Götze, which was published in response to the article by Otto in Deutsches Ärzteblatt.
Prof. Dr. med. Klaus Friese
Prof. Dr. med. Christian Stief
Dr. med. Ricarda Bauer
PD Dr. med. Christian Dannecker
Klinikum der Universität München
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe – Großhadern
81377 München, Germany
Conflict of interest statement
Ms Bauer has received honoraria for speaking from Astellas Pharma GmbH. PD Dr Dannecker has received honoraria from Ethikon. Professor Stief and Professor Friese declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Ward KL, Hilton P: Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. Bjog 2008; 115: 226–33. MEDLINE|
|2.||Jelovsek JE, Barber MD, Karram MM, Walters MD, Paraiso MF: Randomised trial of laparoscopic burch colposuspension versus tension-free vaginal tape: long-term follow up. Bjog 2008; 115: 219–25; discussion 225. MEDLINE|
|3.||Olsson I, Abrahamsson AK, Kroon UB: Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence: a retrospective follow-up 11.5 years post-operatively. Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21(6): 679–83. MEDLINE|
|4.||Nilsson CG, Palva K, Rezapour M, Falconer C: Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19(8): 1043–7. MEDLINE|
|5.||Dannecker Ch, Friese K, Stief Ch, Bauer R: Urinary incontinence in women—part 1 of a series of articles on incontinence. Dtsch Arztebl Int 2010; 107(24): 420–6. VOLLTEXT|