Re: Surgery versus Physiotherapy for Stress Urinary Incontinence

Abstract

for this article http://dx.doi.org/10.1016/j.juro.2013.10.120 available at http://jurology.com/ Editorial Comment: This randomized clinical trial effectively contained 3 arms, a physiotherapy only arm, a physiotherapy followed by mid urethral sling surgery arm and an initial surgery arm. The results are compelling and demonstrate that, while participants in the physiotherapy only arm reported some improvement after treatment, the effect was minimal compared to the effect of surgery, which was significantly better in all quality of life domains except social function and pain. There were no significant differences between participants who underwent initial surgery and those who underwent physiotherapy followed by surgery, implying that there is little benefit to preoperative physiotherapy in these women. This study is highly relevant for 2 reasons. First, the recent Food and Drug Administration warnings about urogynecologic mesh are really focused on the use of mesh in pelvic organ prolapse. When one considers this issue in combination with the findings from this study, it underscores the fact that the mid urethral sling operation is effective and should rightly be considered as first line therapy for women with stress urinary incontinence. The other point revolves around the costeffectiveness of physiotherapy as first line treatment for stress incontinence. Clearly surgery is much more effective but it is also more costly. If physiotherapy can result in a large enough cost savings related to women avoiding surgery, then it may still have a role as a first line treatment. However, I suspect that the impact will not be great enough to justify the use of physiotherapy, and to this end, surgery is likely the most cost-effective approach. David F. Penson, MD, MPH Benign Prostatic Hyperplasia Re: Comparison of the Response to Treatment between Asian and Caucasian Men with Benign Prostatic Hyperplasia: Long-Term Results from the Combination of Dutasteride and Tamsulosin Study B. H. Chung, S. H. Lee, C. G. Roehrborn, P. F. Siami, K. Major-Walker, T. H. Wilson and F. Montorsi; CombAT Study Group Department of Urology, Yonsei University Health System, Seoul, Korea Int J Urol 2012; 19: 1031e1035. Abstract for this article http://dx.doi.org/10.1016/j.juro.2013.10.088 available at http://jurology.com/for this article http://dx.doi.org/10.1016/j.juro.2013.10.088 available at http://jurology.com/ Editorial Comment: There appears to be consistency in the literature regarding ethnic differences in prostate growth and development. For example Asian men generally tend to have smaller prostates than white men. Interestingly this finding does not necessarily translate into a decreased