The SISTER trial (2004) compared Burch colposuspension versus autologous fascial pubovaginal sling for urodynamic stress incontinence (USI). What was the key finding that influenced current management of USI?

• A Both had similar success rates at 2 years but fascial sling had higher rates of urge incontinence de novo and voiding dysfunction ✓
• B Fascial sling was significantly superior to Burch at 2 years with 80% vs 50% success
• C Burch colposuspension was superior to fascial sling for USI with concurrent prolapse repair
• D Both procedures were equivalent with identical complication rates at 5-year follow-up

Explanation

The SISTER trial (Stress Incontinence Surgical Treatment Efficacy Research) compared Burch colposuspension versus autologous fascial pubovaginal sling. At 24 months, the fascial sling had slightly higher overall success (47% vs 38%), but this came at the cost of significantly higher rates of de novo urge incontinence (26% vs 19%) and urinary tract infection, with higher rates of voiding dysfunction requiring prolonged catheterization. This trial influenced the adoption of mid-urethral synthetic slings (TVT, TOT) as the procedure of choice for USI, as they combine good efficacy with lower morbidity compared to both historical procedures. ACOG now recommends mid-urethral slings as the standard surgical treatment for USI.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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