SUFU 2018: What Has the Urinary Incontinence Treatment Network Taught Us?

Austin, TX ( Over the course of its existence, Urinary Incontinence Treatment Network (UITN) trials have been performed over 9 clinical sites and a digestive disease center. It has developed and conducted 4 major randomized controlled trials over 10 years, with its data archived in the NIDDK repository.  Regarding surgical treatment of stress predominant urinary incontinence in women, we now have level 1 evidence for short and medium-term efficacy and safety of burch vs sling and retropubic vs transobturator tape (TOT) midurethral mesh slings.  It has also produced level 1 evidence about value of preoperative urodynamics. 

Dr. Michael Albo discussed the SISTEr trial, which proved the midurethral sling provided better efficacy than the burch colposuspension.  Satisfaction rates were similar between the two groups, but slings had higher complication rates.  The TOMUS trial was conducted to examine if the TOT sling was inferior to the retropubic sling.  At 12 and 24 months, the differences between the two were minimal.  There were more adverse events in RP sling (bladder perforation, voiding dysfunction, UTI), and the TOT sling had more neurologic symptoms.  There was no difference in mesh complications between the two.  Quality of life improvements occurred rapidly after surgery and were sustained at 24 months in both groups. 

UITN trials were performed on UDS in order to standardize and give reference values, as well as provide predictive value of baseline parameters. Most importantly, this work was able to provide evidence for the value of preop UDS. Through this, researchers were able to determine predictors of success and adverse events.  The VALUE trial found that in patients desiring surgery for SUI, office evaluation alone for SUI was not inferior to office evaluation plus UDS. There was no difference in severity of incontinence, quality of life, and satisfaction measures between the two groups.  In the BE-DRI study, researchers found that the addition of PME to anticholinergic therapy does not improve outcomes in OAB. 

Dr. Albo concluded that the UITN has demonstrated that patients are willing to be randomized and surgeons are willing to standardize outcomes and procedures.  He also makes note that patient study populations may not be diverse in these trials and because of this, may not be generalizable to the general population. 

Presented by: Michael E. Albo, MD

Written by: Cristina Palmer, DO. Female Urology, Pelvic Reconstruction, Voiding Dysfunction Fellow, Department of Urology, UC Irvine Medical Center, Orange, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas