Women & Infants Hospital announced today that results from two large, groundbreaking research trials conducted through the Division of Urogynecology and Reconstructive Pelvic Surgery at Women & Infants have recently been published in the Journal of the American Medical Association (JAMA). The first article authored by Vivian Sung, MD, MPH, professor at The Warren Alpert Medical School of Brown University, evaluates the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (the ESTEEM trial). The second trial compares two different surgical treatments for uterine prolapse (the SUPeR trial). Both studies were conducted by the Pelvic Floor Disorders Network (PFDN), funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women’s Health, both part of the National Institutes of Health (NIH).
“Congratulations to Dr. Sung for her leadership and clinical expertise .These are exciting times in the area of research for Women & Infants Hospital and for the patients who will benefit from these findings,” said Matt Quin, interim chief operating officer at Women & Infants Hospital, “Both articles published in JAMA are a testament to the cutting-edge research being conducted and offered to patients at Women & Infants. This sets the standard in research, and ensures the highest quality of clinical care for our patients.”
The ESTEEM trial compares behavioral and pelvic floor muscle therapy combined with sling surgery versus sling surgery alone on improving mixed urinary incontinence symptoms. Women with mixed incontinence can be more difficult to treat because they have two different types of incontinence (stress and urgency incontinence). In this study, investigators found that sling surgery alone designed to treat stress urinary incontinence also improves urgency urinary incontinence, with a very low rate of complications. Adding behavioral and pelvic floor therapy to surgery did not result in a clinically meaningful improvement in symptoms. Most patients in both groups reported a marked reduction in both types of incontinence at one year.
These findings challenge current practice guidelines for treating women with mixed incontinence, which approach surgery with caution for mixed urinary incontinence.
“The results of our study suggest that current practice guidelines may be unnecessarily delaying surgery for women with mixed urinary incontinence” said Dr. Sung, lead author and the principal investigator for the PFDN at the Women & Infants/Brown site. “Our findings have broad implications since one-third to one-half of women with urinary incontinence have mixed incontinence. We hope these findings will improve the care and treatment for women with incontinence.”
The SUPeR trial which was also published in JAMA, was designed to determine if a vaginal mesh hysteropexy is comparable to the typical surgery for uterovaginal prolapse which typically includes a vaginal hysterectomy and a suture repair. The article was co-authored by Charles Rardin, MD from Women & Infants Division of Urogynecology. The investigators did not find a significant difference between the two surgical options after three years. Further research (including continued follow-up in this trial) is needed to assess whether one treatment may be superior.
To see both articles in their entirety, please visit jamanetwork.com.
Vivian Sung, MD, MPH, FACOG, is professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Sung is a graduate of Tufts University School of Medicine and completed a residency in obstetrics and gynecology at Magee-Women's Hospital. Following residency, Dr. Sung completed a dual fellowship in urogynecology and reconstructive pelvic surgery and epidemiology and clinical trials at Women & Infants Hospital.
Dr. Sung is an active researcher and serves as the director of research for the Division of Urogynecology. Dr. Sung achieved certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) by the American Board of Obstetrics and Gynecology (ABOG). She is a fellow of the American Gynecological & Obstetrical Society (AGOS) and is past president of the Society for Gynecologic Surgeons. Dr. Sung is committed to advancing the field of urogynecology and improving patient care through rigorous and patient-centered research.
Charles Rardin, MD, FACOG, is a professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Rardin is a graduate of the University of Rochester School of Medicine and completed a residency in obstetrics and gynecology at Beth Israel Deaconess Medical Center. Following residency, Dr. Rardin completed a fellowship in urogynecology and pelvic reconstructive surgery at Mount Auburn Hospital and Harvard Medical School. He is a fellow of the American College of Obstetricians and Gynecologists, as well as the American College of Surgeons. Dr. Rardin has a particular interest in innovative, minimally invasive techniques for the treatment of a variety of conditions of pelvic floor dysfunction. He is past president of the American Urogynecologic Society. He is committed to the academic advancement of the field of urogynecology.