Prophylactic midurethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of postoperative de novo stress urinary incontinence

Lo, Tsia‐Shu; Chua, Sandy; Kao, Chuan Chi; Hsieh, Wu‐Chiao; Wu, Ming‐Ping; Tseng, Ling-Hong

doi:10.1007/s00192-018-3787-z

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…22 Though concurrent MUS was done to patients with USI, none of them had voiding dysfunction. Similarly in our previous study 20 , patients who underwent prophylactic MUS insertion together with prolapse surgery did not experience voiding dysfunction either. DO was persistent in 1 patient and may have been due to extensive paravesical dissection that damaged the motor parasympathetic nerves, impairing detrusor contraction.…”

Section: Discussionsupporting

confidence: 79%

“…Whereas patient with no USI preoperatively but with known risk factors may opt for prophylactic MUS insertion as it lowers its incidence to 5%. 20 In our opinion, the Uphold TM -LITE system has a unique method of deployment that afforded good anterior and apical support provided by the mesh. Tensioning was done with the prolene strip that provides rigid non-absorbable tension.…”

Section: Discussionmentioning

confidence: 99%

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Polypropylene Anterior-apical single-incision mesh surgery in women with severe pelvic organ prolapse—a case series at 53 months median period follow-up

Chua

Shen

et al. 2022

Preprint

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Objective This study aims to assess the medium-term outcomes of UpholdTM-LITE system for treatment of advanced pelvic organ prolapse (POP). Methods This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UpholdTM-LITE system. Objective outcome measure was the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient’s feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on UDI-6, IIQ-7, POPDI-6, and PISQ-12 at 1 and 3 years post-operatively. Results Objective outcome at 1 and 3 years was at 96.7% and 95.4% respectively. The subjective cure was 95.1% and 91.6%. Five-year cumulative cure rate maintained at 87.2%. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction (BOO) improved while De novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8%. Conclusion The UpholdTM-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, a slight increased in De novo USI was observed.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Polypropylene Anterior-apical single-incision mesh surgery in women with severe pelvic organ prolapse—a case series at 53 months median period follow-up

Chua

Shen

et al. 2022

Preprint

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“…Combination surgery for POP and SUI carries a risk of postoperative voiding dysfunction with an incidence ranging from 2.4% to 24% 11 . Pelvic reconstructive surgery only has been associated with the development of UI postoperatively 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Combination surgery for POP and SUI carries a risk of postoperative voiding dysfunction with an incidence ranging from 2.4% to 24%. 11 Pelvic reconstructive surgery only has been associated with the development of UI postoperatively. 12 Although the pathophysiologic mechanism for the development of postoperative UI is not well understood, it has been hypothesized that the maximal point of descent from prolapse can preserve continence by compressing the urethra; correction of prolapse can then consequently unmask SUI.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Urinary Incontinence in Diabetic Patients Undergoing Pelvic Reconstructive Surgery

Siddique

Ringel

Winter³

et al. 2022

Female Pelvic Med Reconstr Surg

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ImportanceDiabetes is an independent risk factor for urinary incontinence, and its impact on rates of postoperative incontinence after pelvic reconstructive surgery remains unexplored.ObjectiveThe aim of the study was to compare the incidence of postoperative stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence in patients with diabetes mellitus undergoing surgery for pelvic organ prolapse (POP) with or without SUI surgery.Study DesignThis is a secondary analysis of a multicenter retrospective cohort study involving 10 diverse medical centers that identified a cohort of women with diabetes who had prolapse and/or anti-incontinence surgery. We compared rates of postoperative urinary incontinence among patients who had surgery for prolapse and incontinence versus surgery for prolapse only.ResultsThree hundred five patients had surgery for prolapse and incontinence, 330 had surgery for prolapse only, and 189 had anti-incontinence surgery only. De novo UUI was higher among those who underwent surgery for POP and SUI compared with surgery for POP alone (26.4% vs 14.1%, P < 0.01). Rates of persistent SUI (21% vs 4.9%, P < 0.01) and mixed urinary incontinence (15.9% vs 2.7%, P < 0.01) were higher for those who underwent prolapse surgery alone versus prolapse and an incontinence procedure. No differences were seen in hemoglobin A1C levels between those who did and did not report postoperative UI.ConclusionsWe found that postoperative de novo UUI rates were high among patients with diabetes after pelvic reconstructive surgery, with the incidence being significantly higher for those who had surgery for prolapse and incontinence compared with surgery for prolapse only.

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“…The NNT to prevent 1 woman from developing postoperative SUI using the universal approach varies from 6, to 3 to 9 4,8 , and for performing a selective procedure in women with occult SUI, the NNT is 3 4,30 . In a prospective cohort study, in patients with POP stage ≥ 3, MUCP<60 cmH 2 O and functional urethral length (FUL) <2 cm, the rate of postoperative SUI in the concomitant surgery group was 5% objectively and 10% subjectively, while in the POP surgery group it was 50% and 60%, respectively 31 . Our study showed that the incidence of moderate or above postoperative SUI in OSUI patients who did not receive anti-incontinence surgery was 20.0% (15/75), compared to 2.8% (8/282) in the POP surgery group, indicating the relative risk of postoperative SUI in OSUI patients was increased nearly 7.1 folds.…”

Section: Sui Often Coexists With Popmentioning

confidence: 99%

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

Xia

et al. 2020

Preprint

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This retrospective cohort study aims to explore the clinical value of urodynamics in evaluating lower urinary tract function in pelvic organ prolapse (POP) patients, and to investigate the urodynamic characteristics of POP patients with occult stress urinary incontinence (OSUI) in whom moderate or above postoperative SUI eventually occurred after prolapse surgery. The medical records of 626 advanced POP patients who underwent vaginal pelvic reconstructive surgery were analyzed. The patients with anterior compartment prolapse were more susceptible to urodynamic changes than those with apical or posterior compartment prolapse (95.1% vs. 40.15%). The proportion of patients with urodynamic abnormality was increased with prolapse severity (68.8% vs. 78.6%). After 3 months, the incidence of moderate or severe postoperative urinary incontinence in the OSUI patients was 20%, while it is 2.8% in non-OSUI patients. In subgroup analysis of OSUI patients, the urodynamics of patients with moderate or above postoperative urinary leakage showed significantly lower Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), maximal bladder volume (MBV) and maximum urine flow rate (MUFR). For POP patients with OSUI, anti-incontinence surgery is only recommended for whom with lower VLPP, MUCP, MBV and MUFR to avoid the risk and costs of secondary surgery or overtreatment.

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Prophylactic midurethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of postoperative de novo stress urinary incontinence

Cited by 12 publications

References 29 publications

Polypropylene Anterior-apical single-incision mesh surgery in women with severe pelvic organ prolapse—a case series at 53 months median period follow-up

Polypropylene Anterior-apical single-incision mesh surgery in women with severe pelvic organ prolapse—a case series at 53 months median period follow-up

Postoperative Urinary Incontinence in Diabetic Patients Undergoing Pelvic Reconstructive Surgery

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

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