Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence

Borstad, Ellen; Abdelnoor, Michael; Staff, Anne Cathrine; Kulseng‐Hanssen, Sigurd

doi:10.1007/s00192-009-1007-6

Cited by 116 publications

(85 citation statements)

References 27 publications

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“…9 That study by Borstad et al showed more benefit from combination surgery than seen in our trial. Two differences between the studies might explain the lower percentage of women undergoing additional MUS after index surgery (57% versus 17% in our trial).…”

Section: Discussionmentioning

confidence: 37%

“…A meta-analysis of the pooled complication rates of the Borstad et al study and the OPUS trial also showed slightly more adverse events in the MUS group (15% versus 10%; RR 1.6; 95% CI 1.0-2.5). 4,9,24 Obviously, additional procedures will increase the risks of expected complications. However, the rate of severe complications in our study was higher than one would expect from simply adding the complication risk of MUS to POP surgery alone.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The second compared vaginal prolapse repair with and without midurethral sling (MUS). 9 Adding MUS significantly reduced the risk of SUI at 1 year: 5% (4/87) versus 23% (22/94). Initially the complication rate was higher after combination surgery.…”

Section: Introductionmentioning

confidence: 91%

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Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Ploeg

Rengerink

Steen

et al. 2015

BJOG

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Objective To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only.Design Multi-centre randomised trial.Setting Fourteen teaching hospitals in the Netherlands.Population Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction.Methods Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat.Main outcome measures The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications.Results One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54).Conclusions Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A wellinformed decision balancing risks and benefits of both strategies should be tailored to individual women.Keywords Midurethral sling, pelvic organ prolapse, randomised, stress urinary incontinence.Tweetable abstract Combination of prolapse repair with midurethral sling reduces the risk of postoperative stress incontinence.Please cite this paper as: van der Ploeg JM, Oude Rengerink K, van der Steen A, van Leeuwen JHS, Stekelenburg J, Bongers MY, Weemhoff M, Mol BW, van der Vaart CH, Roovers J-PWR, on behalf of the Dutch Urogynaecology Consortium*. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG 2015;122:1022-1030.*The complete list of authors and collaborators from the Dutch Urogynaecology Consortium are listed in Supporting Information Appendix S1.Trial registration: The Netherlands National Trial Register NTR1197 (www.trialregister.nl).

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Section: Discussionmentioning

confidence: 37%

Section: Discussionmentioning

confidence: 99%

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Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Ploeg

Rengerink

Steen

et al. 2015

BJOG

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“…The majority of the previous studies implied that concomitant prophylactic surgery caused better surgical outcomes. In contrast, there was no statistically signifi cant difference of concomitant surgery according to the study of Borstad et al [14] but the prevalence of postoperative SUI was less in the group who had concomitant surgery than the group who had no concomitant surgery. However 27% (almost one third) of patients were cured of SUI by prolapse surgery alone, which meant that some preoperative SUI could be corrected by only prolapse surgery.…”

Section: Discussionmentioning

confidence: 84%

Effective parameters of urodynamic study before pelvic organ prolapse surgery and validation of concomitant surgery on urinary outcomes: Retrospective cohort study

Cho

Kim

Moon

et al. 2012

Korean J Obstet Gynecol

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“…However, after the additional insertion of a suburethral tape, 235 out of 237 women (99 %) were continent postoperatively [87,[127][128][129]. One randomized study investigated the question whether treatment should be carried out as a one-stage or a two-stage procedure; it was found that the treatment of stress incontinence was equally successful, irrespective of whether the suburethral TVT was inserted at the same time as the anterior vaginal wall repair (83/87, 95%) or three months later (47/53, 89%; based on an ontreatment analysis) [130]. However, 27/94 women (29%) were continent following prolapse surgery alone and refused the planned TVT procedure three months later [130].…”

Section: Women With Symptomatic Stress Urinary Incontinence and Genitmentioning

confidence: 99%

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Baeßler

Aigmüller

Albrich

et al. 2016

Geburtshilfe Frauenheilkd

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Ziel: Erstellung einer offiziellen, internationalen, interdisziplinären Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Die Leitlinie wurde für den deutschsprachigen Raum entwickelt und wird neben der DGGG auch von der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) und der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) mitgetragen. Das Ziel dieser Leitlinie, die von der DGGG publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen evidenzbasierten Überblick über die Diagnostik sowie konservative und operative Therapie des Descensus genitalis der Frau mit oder ohne Belastungsinkontinenz zu geben. Methoden: Es erfolgte ein systematischer Review sowie Synthese von Daten, anteilig mit Metaanalyse (S2e). Es wurde eine umfassende Literatursuche in MEDLINE, Embase, Cinahl, Pedro und im Cochrane-Register, in Referenzlisten und in den Abstracts der Annual Meetings der International Continence Society und der International Urogynecological Association durchgeführt. Abstracts wurden eingeschlossen, wenn es sich um randomisierte Studien handelte, die als Podiumpräsentation vorgestellt und diskutiert wurden. Es wurden Originalarbeiten seit 2008 eingeschlossen, deren Nachkontrollzeitraum bei mindestens 12 Monaten lag. Für die Beschreibung von perioperativen Komplikationen wurden jegliche Daten herangezogen. Empfehlungen: Es werden Empfehlungen zur Diagnostik, konservativen und operativen Therapie des Genitaldeszensus gegeben, wobei die 3 urogynäkologischen Kompartimente, Prävention oder Behandlung von Belastungsinkontinenz, Vor-und Nachteile von Netzaugmentationen sowie uteruserhaltende Optionen, berücksichtigt

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Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence

Abstract: No differences were found between the two treatment strategies, but almost one third of women were cured of SUI by prolapse surgery alone.

Cited by 116 publications

References 27 publications

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Effective parameters of urodynamic study before pelvic organ prolapse surgery and validation of concomitant surgery on urinary outcomes: Retrospective cohort study

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

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