International Urogynecology Journal

, Volume 26, Issue 8, pp 1095–1102 | Cite as

Surgery for urinary incontinence in women 65 years and older: a systematic review

  • Karin FranzenEmail author
  • Gunnel Andersson
  • Jenny Odeberg
  • Patrik Midlöv
  • Eva Samuelsson
  • Karin Stenzelius
  • Margareta Hammarström
Review Article


Introduction and hypothesis

Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.


Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.

The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.


Five studies—all on the suburethral sling procedure in women— that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.


The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.


Elderly Surgery Systematic review Urinary incontinence 



We are very thankful to Elisabeth Gustafsson and Hanna Olofsson, librarians, for their administrative help with the literature search.

Conflicts of interest


Details of ethical approval

Ethical approval not required


The study was financed by the Swedish Council on Technology Assessment in Health Care (SBU)

Supplementary material

192_2014_2573_MOESM1_ESM.docx (107 kb)
Appendix S1 (DOCX 106 kb)
192_2014_2573_MOESM2_ESM.docx (75 kb)
Appendix S2 (DOCX 74 kb)


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Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • Karin Franzen
    • 1
    • 2
    Email author
  • Gunnel Andersson
    • 3
  • Jenny Odeberg
    • 4
  • Patrik Midlöv
    • 5
  • Eva Samuelsson
    • 6
  • Karin Stenzelius
    • 7
  • Margareta Hammarström
    • 8
  1. 1.School of MedicineÖrebro UniversityÖrebroSweden
  2. 2.Department of Obstetrics and GynecologyÖrebro University HospitalÖrebroSweden
  3. 3.School of Health and Medical SciencesÖrebro UniversityÖrebroSweden
  4. 4.Swedish Council on Health Technology Assessment (SBU)StockholmSweden
  5. 5.Center for Primary Health Care ResearchLund UniversityMalmöSweden
  6. 6.Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
  7. 7.Department of Care ScienceMalmö UniversityMalmöSweden
  8. 8.Department of Clinical Science and EducationKarolinska InstitutetStockholmSweden

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