To compare the short- and medium-term outcomes of laparoscopic colposuspension (LC) and mid-urethral tape (MUT) for treatment of stress urinary incontinence (SUI) in women.

Stress urinary incontinence is a common condition with significant effect on the quality of life. Current evidence suggests MUT are more effective than Burch colposuspension (OC) for treatment of SUI. However, mesh complications represent significant problem and are on the rise. Surgical alternatives to mesh tape are needed that maintain the day-surgery advantage. Traditionally, prior to development of the MUT procedures, open colposuspension (OC) was the gold standard surgical treatment, however, hospital stay and recovery is longer due to the laparotomy approach. LC could be surgical alternative as it has good success rates with short hospital stay. 

This study used an anonymised dataset, obtained from the online surgical database of the British Society of Urogynaecologists (BSUG). From January 2010 to December 2017, 40 women received LC and 145 women MUT. Standard validated symptom questionnaire (ICIQ-UI SF) was used for patient-reported efficacy outcomes. The two groups were compared regarding the incidence of post-operative complications and length of hospital stay. The average length of follow-up after surgery for LC was 5.8 months (range 2.8-8.8) compared to 4.1 months for MUT (range 1.6-6.6).

There was no difference between the groups in Body Mass Index (BMI) (P= 0.53), however women in the MUT cohort were significantly older (P<0.01; 95%CI 5.1± 3.8) and had lower parity (P<0.01; 95% CI -1.2± 0.5) than women in LC cohort. Pre-operative ICIQ-UI score was significantly lower in MUT group comparing to LC group (P<0.01; 95%CI -2.3± 1.7).

Table 2 showed both procedures were similarly effective in treating stress urinary incontinence in women. The ICIQ-UI score reduced significantly in both cohorts following the surgical treatment. The statistical analysis of the change between pre- and post-operative ICIQ-UI score in the two groups there were no significant group differences (p=0.26).
The adverse events rate was 3.3% (3/90) for the MUT group and 10% (4/40) for the LC group. The difference between groups is not significant (P = 0.13; Fisher exact test); difference 6.7%, Newcombe –Wilson 95% confidence interval -1.9% to 20.0%) and the risk ratio for LC against MUT is 3.0 (95% CI 0.70, 12.8). 
 
Both cohorts were very similar in the length of postoperative hospital stay. Around 25% were day cases, 45% of cases stayed one day, 25% stayed two days and 5% stayed longer than two days. There was no significant difference in length of stay between the two groups (Fishers exact test, p =0.38).
There were no episodes of the return to theatre for the procedure-related event within 72 hours.

The laparoscopic colposuspension is comparable to Mid urethral tape for the treatment of SUI in short- to medium-term. This treatment should be considered as a viable minimal access alternative on offer for women with bothersome SUI. Longer follow up of larger randomised study is required to provide further evidence on efficacy and safety.