Continence surgery at the time of pelvic organ prolapse repair: a review of the literature

Abstract

Key content Pelvic organ prolapse and incontinence are significant health problems; one in nine women are affected by prolapse and one in three by stress urinary incontinence. Pelvic floor muscle training remains the first‐line treatment for stress urinary incontinence. Concomitant surgical correction for coexisting symptomatic prolapse and incontinence is an option for treatment, but persistent postoperative incontinence can be challenging to manage. Delayed or interval continence procedures may be beneficial and should be discussed with women preoperatively. Learning objectives To understand the health burden and prevalence of pelvic organ prolapse and incontinence in the population. To understand the surgical treatment options available. To learn about the advantages and disadvantages of concomitant surgery in patients with symptomatic or occult stress incontinence and in those who are continent. Ethical issues Should transvaginal prolapse repair and concomitant synthetic miduretheral sling be offered to women without stress urinary incontinence? Should all women be preoperatively screened for occult stress urinary incontinence, given its prevalence and implications for postoperative outcomes?

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“…In up to 80% of women with PF dysfunction, POP will coexist with SUI due to the related pathophysiology of these conditions (Loganathan et al, 2019). SUI is the involuntary leakage of urine when pressure is exerted on the abdomen, for instance, when exercising, coughing or sneezing.…”

“…According to clinical guidelines, including those stipulated by the UK National Institute for Health and Care Excellence (NICE) and the European Association of Urology (EAU), pelvic floor muscle training (PFMT) should be the initial treatment method offered to patients presenting with SUI or mild-to-moderate POP (Loganathan et al, 2019). PFMT is a non-surgical treatment method that aims to strengthen the muscles of the PF with repeated muscle contractions.…”

“…Although the true prevalence of these conditions is difficult to determine, it is estimated that one in three and one in nine women are affected by SUI and POP, respectively (Loganathan et al, 2019). While these disorders are not life-threatening, they reduce the quality of life for women due to the negative impact inflicted upon their social, physical and psychological wellbeing (Abdel-Fattah et al, 2011).…”

“…Up to 20% of these women will undergo at least one surgical procedure for SUI or POP during their lifetime, creating substantial cost implications for healthcare systems (Dieter et al, 2015). The United Kingdom (UK) National Health Service (NHS) spends approximately £233M on urinary incontinence treatment annually, and over £45M was spent on POP treatment between 2017-2018 in England alone (Loganathan et al, 2019;Primary Care Women's Health Forum, 2019). Although healthcare costs for urinary incontinence vary among countries, the total expenditure, both direct and indirect, in Europe is nearly €10b, with the majority spent on SUI (Zwolsman et al, 2019).…”