Sling surgery may be best for incontinence

But the sling created more side effects, particularly urinary tract infections, which affected 63 percent of those women, compared to 47 percent of the Burch women. The sling also created more problems with urination (14 percent vs. 2 percent). Nineteen of the women with slings needed surgery to correct problems voiding, while no one in the Burch group needed it.

"There is a price to be paid, because the sling is a stronger surgery, so more people had trouble going to the bathroom afterwards," Norton said.

Knowing the potential benefits and risks opens up conversations between women and their physicians, Norton said. They can talk about the patient's particular situation and make good decisions with actual data, which has been lacking.

Testing was completed at a biostatistical center and nine clinical centers, including U. Hospital.

The researchers warn that cure rates for incontinence decline with age. While it's not a condition that is life-threatening, said Norton, "among all the common conditions, urinary incontinence is a particularly bothersome one, comparable to arthritis and chronic renal failure. It affects quality of life."

Given the side effects, Norton said some women and their physicians will likely choose the Burch. "If you already have problems with bladder infections, you might prefer a Burch." And some of the benefits of the sling go away in certain cases, including for a woman who is already having an open-abdominal surgery.

There are also other stress incontinence procedures and treatments, including use of a mesh sling. Those have not yet been compared in a randomized, scientific way, Norton said. Currently, there's a study comparing two mesh slings and the "better one will go head-to-head with the fascial (human tissue) sling."

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