Prospective randomised controlled trial comparing laparoscopic and open colposuspension

WC Cheon, JHL Mak, JYS Liu
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital

OBJECTIVE. To compare the efficacy, safety, complications, and short-term outcome of laparoscopic and open colposuspension in women with genuine stress incontinence.

DESIGN. Randomised controlled trial.

SETTING. Urogynaecology unit in a public hospital, Hong Kong

SUBJECTS AND METHODS. Ninety patients with urodynamically proven genuine stress incontinence. Forty-three patients were randomly allocated to receive open colposuspension and 47 to undergo laparoscopy. All patients had reassessment within 1 year of the operation.

MAIN OUTCOME MEASURES. Objective and subjective measures and complication rates.

RESULTS. There was no significant difference in the duration of stress incontinence, mean preoperative pad test results, or proportion with pre-existing detrusor instability. Among patients in the laparoscopic group, the mean operating time was significantly longer (42.0 minutes versus 29.3 minutes; P<0.0001), while the mean blood loss was significantly less (124.7 mL versus 326.9 mL; P=0.001). Subjective and objective success rates within 1 year were similar for patients in the open and laparoscopic groups (86.0% versus 80.9%; P=0.58, and 86.0% versus 85.1%; P=1.00, respectively). There was no significant difference in the rate of complications, including de novo detrusor instability and an obstructive voiding pattern, enterocele, or dyspareunia.

CONCLUSION. Laparoscopic colposuspension is a feasible alternative to the open approach. The operating time is longer but the short-term cure rate is comparable with that of the open approach.

Hong Kong Med J 2003;9:10-4

Key words: Laparoscopy; Urinary incontinence, stress