Urinary incontinence constitutes a common and significant public health challenge in the United States, a challenge that is continuously compounded by the """"""""graying"""""""" of America and by the ever improving life expectancy for women. Outcomes following surgery for urinary incontinence have not been ,adequately evaluated. As a result, objective, rigorously-obtained data, required to fully inform patients and on which to base important policy decisions, are unavailable. The long-term objective of the Urinary Incontinence Treatment Network (UITN) is to systematically evaluate the long-term outcomes of commonly utilized therapeutic approaches for urinary incontinence. This proposal describes the strengths that the University of Utah Continence Center would bring if it were to become a member Continence Treatment Center (CTC) of the UITN. Specifically, we will demonstrate the extensive expertise of the Utah Continence Center in the evaluation and treatment of urinary incontinence, including non-surgical and surgical approaches. We will further document that the Utah Continence Center has the- necessary ability to participate in or lead multicenter clinical trials, and that the Department of Obstetrics and Gynecology at the University of Utah Health Sciences Center, 14th'in the nation in NIH awards, has a proven track record in participating and managing NIH-driven multicenter network studies. Finally, we propose to carry out a prospective, randomized clinical trial for the two proposed surgical procedures (Bunch colposuspension versus pubovaginal sling) rather than a prospective cohort study, since the three investigators-surgeons for the Utah CTC can perform both procedures with equal expertise. Thus, inclusion of the proposed Utah CTC will increase the likelihood that the UITN will be in a position to complete a randomized controlled trial as the final outcome.
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