Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence

Abstract

Background:The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI.Methods:A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples.Results:A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2= 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2= 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2= 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05).Conclusions:No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.

Clinical efficacy of pelvic autologous tissue reconstruction in treating pelvic organ prolapse in 36 patients

“…The reason may be that pelvic floor reconstruction strengthens the urination control ability in the middle segment of the urethra. [ 25 ] The results of the present study revealed that at 3 and 12 months after the operation, the BND was significantly smaller in the PAR group than in the TO group. This suggests that autologous pelvic floor reconstruction is better than TOs in improving BND and has a certain preventive effect on new SUI after the operation.…”

Postoperative Urinary Incontinence in Diabetic Patients Undergoing Pelvic Reconstructive Surgery

“…Recent studies report incidence rates of 22%-53% for persistent or worsened MUI symptoms postoperatively, but outcomes were not stratified by surgical type in these studies. 8,27 In our study, we reported on outcomes of MUI by POPonly versus POP and SUI surgery. The POP and SUI surgery group had a significantly lower rate of persistent MUI compared with those who had surgery for POP only.…”

“…The risk of de novo UI after PRS has been reported as approximately 15%, whereas rates of resolution of UI symptoms after PRS with and without continence procedures are approximately 40%. [7][8][9][10] The relationship between PRS and incidence of postoperative UI has not been explored among patients with diabetes specifically. Given the unique risk profiles of patients with diabetes relative to UI, it is important to understand this population's risk of postoperative UI after PRS to ensure proper counseling.…”

“…The association between PRS and postoperative UI has been investigated in other studies, with various findings reported in the literature. The risk of de novo UI after PRS has been reported as approximately 15%, whereas rates of resolution of UI symptoms after PRS with and without continence procedures are approximately 40% 7–10 . The relationship between PRS and incidence of postoperative UI has not been explored among patients with diabetes specifically.…”

Clinical value of needleless sling in treatment of female stress urinary incontinence

“…Needleless straps, as a product of modern medical advancements, have been designed by Spanish doctors to further improve the technique[ 17 ]. The two ends of a T-type bag are used for the needle-free sling and as a whole are considered a "worker" type; the length of the sling is 11.4 cm, the width of the pockets at both ends is 2.2 cm, and the width of the middle of the sling is 1.2 cm.…”