***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objectives : To describe the impact of surgery for stress incontinence on the severity of symptoms , other mental and physical symptoms , and overall health . To describe the incidence of postoperative complications . Design : Prospect i ve cohort study ; question naires completed by patients before and 3 , 6 , and 12 months after surgery . Question naires completed by surgeons both before and after surgery . Setting : 18 hospitals in the North Thames region . Subjects : 442 women treated surgically for stress incontinence between January 1993 and June 1994 . 367 women returned the 3 month question naire ; 364 returned the 6  month question  naire ; and 359 returned the 12 month question  naire . 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278 . Main outcome measures : Stress incontinence symptom severity index , other urinary symptoms , bowel function , mental health , complications , global measures . Results : Most women ( 288 ; 87 % ) reported an improvement in the severity of their stress incontinence , though only 92 ( 28 % ) were cured ( continent ) . These improvements persisted for at least 12 months . The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery . Following surgery , women were less likely to suffer from urinary frequency , nocturia , postvoid fullness , dysuria , and urgency . While mental health improved for 194 ( 71 % ) , a quarter of women reported deterioration . Only 37 ( 10 % ) were satisfied with postoperative pain control . A third experienced one or more complications while in hospital , most commonly difficulty urinating . This problem affected 1 in 11 women after discharge . A year after surgery two thirds of women reported feeling better ( 251 ; 72 % ) , that the outcome met or exceeded their expectations ( 230 ; 66 % ) , and that they would recommend the operation to a friend in a similar situation ( 239 ; 68 % ) . Surgeons tended to be more optimistic about the effects of surgery ; they were satisfied with the outcome in 176 ( 85 % ) cases and would again treat 245 ( 94 % ) of the women as they had done previously . Conclusions : Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest . Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications , including postoperative pain . Urgency and urge incontinence should not be considered contraindications to surgery . The need for urodynamic assessment before surgery should be reappraised . Key messages Although surgery improves stress incontinence in most women ( 87 % ) , only 28 % are continent one year later The need for preoperative urodynamic testing should be reappraised Urgency and urge incontinence should not be considered contraindications to surgery Women considering surgery should receive more accurate information on the probability of an improvement in symptoms and possible complications There is a need for a rigorous , pragmatic , r and omised trial of surgery for stress A total of 51 consecutive female patients with genuine stress incontinence who underwent a Burch or Stamey operation  were clinical ly and urodynamically evaluated preoperatively at least 8 months postoperatively . Our study group consisted of 27 women who underwent the Burch colposuspension and 24 who had the Stamey endoscopic bladder neck suspension .  The urodynamic parameters which were studied pre- and postoperatively were the maximum flow rate ( Qmax ) , the residual urine ( Vres ) , the first sensation ( FS ) , the bladder capacity ( BC ) , the maximum vesical pressure ( Pves max ) , the detrusor pressure at maximum flow ( Pdet/Qmax ) , the functional urethral length ( Lfun ) and the maximum closure pressure ( Pclos max ) . The successful results of the operations were 89 % for Burch and 83 % for the Stamey procedure . As for differing objective urodynamic findings , the Qmax , Pclos max , Vres and Lfun for both groups were the only parameters which showed statistically significant difference after surgery . The statistical comparison of the postoperative urodynamic parameters of the two operative techniques showed that Lfun , Pves max and Pclos max had difference in favor of Burch colposuspension . There were not statistical differences in the other studied parameters . In conclusion , according to the differentiation in the values of Pclos max , Lfun and Pves max , the Burch technique seems to result in a higher increase of patient 's urethral resistance Thirty-nine patients ( from a total of 307 women ) with clinical and urodynamic diagnosis of stress urinary incontinence had cystometric findings consistent with detrusor instability . Detailed multichannel urethrocystometry of these 39 patients revealed that urethral relaxation preceded the bladder contraction by 2 - 5 s. These patients were r and omly allocated to either medical treatment ( n = 21 ) by Ditropan 5 mg t.i.d . for 6 weeks prior to the surgical procedure , or to surgical treatment ( n = 18 ) with no attempt to treat the bladder instability prior to surgery . All patients had repeat clinical and urodynamic evaluation at 3 - 12 months postoperatively . Six of the 39 patients ( 15 % ) still had urethral relaxation and bladder contractions on postoperative urethrocystometry . Four of these 6 patients still had stress urinary incontinence and urethral funneling . These 4 were considered surgical failures . Two of the 39 ( 5 % ) had postoperative detrusor instability in spite of good surgical results . This series suggests that in women with combined stress urinary incontinence and bladder instability , where bladder contraction is preceded by urethral relaxation , there is a more than 90 % chance that bladder instability will disappear after successful operation for stress urinary incontinence One hundred seven consecutive patients with clinical and urodynamic findings of genuine stress incontinence not previously treated were prospect ively allocated in a r and omized manner to one of three surgical procedures : anterior colporrhaphy , revised Pereyra procedure , or Burch retropubic urethropexy . R and omization included the surgical procedure and choice of surgeon ( one of the three authors ) . Clinical and urodynamic evaluations were repeated at 3 months and 1 year after surgery . Differences in cure rates among the three procedures at the 3-month postoperative evaluation were insignificant ( 82 % , 84 % , and 92 % for the anterior colporrhaphy , Pereyra , and Burch respectively ) but became statistically significant at the 1 year postoperative evaluation ( cure rates of 65 % , 72 % , and 91 % for the anterior colporrhaphy , Pereyra , and Burch respectively , p less than 0.05 ) . In our h and s the Burch procedure stabilized the urethrovesical junction and prevented its descent during straining ( evaluated by a postoperative Q-tip test ) more effectively than either the Pereyra or anterior colporrhaphy . No procedure result ed in severe postoperative voiding difficulties . The present prospect i ve r and omized study demonstrates that in our h and s the abdominal retropubic operation for genuine stress incontinence in patients not previously operated on results in a higher cure rate when compared with anterior colporrhaphy or Pereyra procedure OBJECTIVES To measure the effect on voiding pressure and flow rate of three different operations for stress urinary incontinence . METHODS In a previous study of cure rates , 289 women with genuine stress incontinence and genital prolapse were prospect ively allocated in a r and omized manner to one of three procedures : the Burch retropubic urethropexy , anterior repair , or the modified Pereyra procedure . In the current derivative study , we retrospectively evaluated the urodynamic indicators of voiding dysfunction in the original subjects preoperatively and at the 1-year postoperative follow-up visit . RESULTS One hundred thirty-two charts were available for review . One year after surgery , pressure and flow during voiding were altered to more obstructive levels with the suspension procedures ( Burch and modified Pereyra ) . The proportion of patients with obstructive and equivocal voiding patterns after the suspension procedures was significantly greater than after anterior repair . CONCLUSIONS This post hoc comparison of r and omized data shows a difference in postoperative voiding indexes between suspension procedures and anterior colporrhaphy . Successful bladder neck suspension depends on altering the pressure and flow during voiding to more obstructive levels . Suspension procedures alter the voiding pressure and flow toward obstruction to a greater extent than anterior repair OBJECTIVE : To estimate costs for incontinence management , health-related quality of life , and willingness to pay for incontinence improvement in women electing surgery for stress urinary incontinence . METHODS : A total of 655 incontinent women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial , a r and omized surgical trial . Baseline out-of-pocket costs for incontinence management were calculated by multiplying self-report of re sources used ( supplies , laundry , dry cleaning ) by national re source costs ( $ 2006 ) . Health-related quality of life was estimated with the Health Utilities Index Mark 3 . Participants estimated willingness to pay for 100 % improvement in incontinence . Potential predictors of these outcomes were examined by using multivariable linear regression . RESULTS : Mean age was 52±10 years , and mean number of weekly incontinence episodes was 22±21 . Mean and median ( 25 % , 75 % interquartile range ) estimated personal costs  for incontinence management among all women were $ 14±$24 and $ 8 ( interquartile range $ 3 , $ 18 ) per week , and 617 ( 94 % ) women reported any cost . Costs increased significantly with incontinence frequency and mixed compared with stress incontinence . The mean and median Health Utilities Index Mark 3 scores were 0.73±0.25 and 0.84 ( interquartile range 0.63 , 0.92 ) . Women were willing to pay a mean of $ 118±$132 per month for complete resolution of incontinence , and willingness to pay increased significantly with greater expected incontinence improvement , household income , and incontinent episode frequency . CONCLUSION : Urinary incontinence is associated with substantial costs . Women spent nearly $ 750 per year out of pocket for incontinence management , had a significant decrement in quality of life , and were willing to pay nearly $ 1,400 per year for cure . LEVEL OF EVIDENCE : OBJECTIVES Stress urinary incontinence affects between 10 percent and 50 percent of women . Surgery is commonly recommended for troublesome incontinence that does not respond to nonsurgical management . Tension-free vaginal tape ( TVT ) is a newer , minimal access surgical sling procedure , which is being increasingly adopted worldwide . The cost-effectiveness of TVT in comparison with other surgical procedures , particularly open colposuspension , is assessed . METHODS Effectiveness estimates came from a systematic review of TVT compared with other surgical procedures ( open and laparoscopic colposuspension , traditional slings , and injectables ) . Deterministic and probabilistic analyses were used to assess the likelihood of  TVT  being cost-effective . Sensitivity analyses assessed the impact of changing assumptions about cure rates and costs for TVT , cure rates for retreatment open colposuspension , and proportions of women who choose retreatment . RESULTS Reliable estimates of relative effectiveness were difficult to derive because the few r and omized controlled comparisons had not been optimally analyzed or fully reported . Results of the economic model suggested that TVT dominates open colposuspension ( lower cost and same quality of life years [ QALYs ] ) within 5 years after surgery . Stochastic analysis indicated that the likelihood of  TVT being cost-effective was 100 percent if decision-makers are unwilling to pay for additional QALYs . TVT 's dominance depended on the assumption fact that retreatment open colposuspension has lower cure rates than a first colposuspension . CONCLUSIONS Analysis based on current short-term data indicates dominance of TVT over open colposuspension from approximately 5 years . There is a need for longer-term follow-up data from method ologically rigorous r and omized trials to provide a sounder basis for estimating the relative benefits and cost implication Objective To determine the sensitivity and specificity of several urodynamic testing methods in the diagnosis of genuine stress urinary incontinence ( GSI ) . Methods One hundred eight consecutive patients were evaluated prospect ively by history and physical examination , cough stress test , and single and multichannel urodynamics . Sensitivities and specificities in detecting genuine stress incontinence were calculated for : a positive cough stress test with a negative cystometrogram , equalization throughout a cough urethral pressure profile , a positive stress leak-point pressure determination , observed urine loss with cough during multichannel urodynamics , and a pressure transmission ratio of less than 90 % for each third of the urethra . Results Sixty-five patients ( 60 % ) were found to have GSI .  Observed urine loss with cough during multichannel studies was 91 % sensitive and 100 % specific . A positive stress leak-point pressure determination had a 78 % sensitivity and was 100 % specific . A positive cough stress test with a negative cystometrogram was 77 % sensitive and 100 % specific . Pressure equalization throughout the length of the urethra during a cough urethral pressure profile was 49 % sensitive and 98 % specific . A pressure transmission ratio of less than 90 % in the distal , middle , and proximal u 
    Output:
    
This effect was seen in both women with primary incontinence and women with recurrent incontinence after failed primary operations .
Needle suspensions may be as effective as anterior vaginal repair ( 50/156 ( 32 % ) failed after needle suspension versus 64/181 ( 35 % ) after anterior repair ; RR 0.86 , 95 % CI 0.64 to 1.16 ) , but there was little information about morbidity .
Bladder neck needle suspension surgery is probably not as good as open abdominal retropubic suspension for the treatment of primary and secondary urodynamic stress incontinence because the cure rates were lower in the trials review ed .
There was not enough information to comment on comparisons with  suburethral sling operations .
A Brief Economic Commentary ( BEC ) identified no cost-effectiveness studies comparing bladder neck needle suspension with other surgeries