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Procedure may prevent incontinence, study says

MILWAUKEE -- Four extra stitches can help prevent a lifetime of bladder problems in tens of thousands of women each year who have surgery to fix sagging internal organs, a new study has suggested.

''It's a very common problem in women, and this is the first time we've been able to demonstrate that an operation can actually prevent urinary incontinence," said Dr. Linda Brubaker of Loyola University, who led the study. Results were published in today's New England Journal of Medicine.

The nationwide study, which was federally funded, was stopped early because the benefits were so clear.

It involved 322 women having surgery for a condition known as uterine prolapse, a painful affliction that occurs when the uterus weakens and sags into the birth canal. Frequent childbirth increases the chances of this happening, and about 200,000 women a year have surgery for the condition.

The operation often leads to bladder control problems. Doctors wanted to see whether adding a second step, called the Burch procedure, could prevent this.

The procedure involves placing four permanent stitches, two on either side, from the vagina to a pelvic ligament. The stitches form a hammock that keeps a urinary control muscle supported.

In the study, only 6 percent of women given the Burch procedure while having surgery for prolapse reported urinary control symptoms three months later, compared with 25 percent of those who did not have the additional procedure.

The technique is named for Dr. John Burch, a Tennessee obstetrician who pioneered it in the 1960s. It is a common treatment for a type of bladder problem known as stress incontinence, when urinary leakage occurs during a cough or sneeze. There are other treatments for this condition as well, and this study was not designed to compare them.

It also was not designed to every method for fixing prolapse, just one very common one.

Still, ''this study provides solid data" to justify adding the Burch procedure with prolapse surgery, Dr. Rebecca Rogers, a gynecologist at the University of New Mexico, wrote in an editorial.

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