Urinary incontinence after surgery for pelvic organ prolapse

Lensen, E.J.M.; Withagen, Mariëlla I. J.; Kluivers, Kirsten B.; Milani, Alfredo L.; Vierhout, Mark E.

doi:10.1002/nau.22327

Cited by 74 publications

(77 citation statements)

References 27 publications

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“…2 Persson et al and Lensen et al also observed that increased BMI was a positively associated risk factor for the development of OSUI. 22,23 The same was observed in our study.…”

Section: Discussionsupporting

confidence: 91%

Study of occult stress urinary incontinence in pelvic organ prolapse

Reddy

Ghose

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common health-related conditions. They affect up to 50% women worldwide individually.1 Stress urinary incontinence is a condition of involuntary loss of urine on effort, physical exertion, sneezing, or coughing that is often bothersome to the patient and frequently affects the quality of life. It is estimated to affect 15.7% of adult women.2 Many times this urinary incontinence is detected following corrective prolapse surgery. If a woman with pelvic organ prolapse leaks only when the prolapse is reduced, it is called occult stress urinary incontinence (OSUI). 3The prevalence of OSUI in women with severe genitourinary prolapse varies from 27-68% in literature. 4,5 If any previously continent woman develops urinary incontinence after vaginal hysterectomy and pelvic floor repair, it is a frustrating condition for both the patient and the physician.So it is important to counsel symptomatically continent women with POP for developing post-operative SUI (POSUI). Bump RC et al and Fianu et al have showed that POP, may mask SUI. 6,7 The colpopexy and urinary reduction efforts(CARE) study, the largest randomized trial, showed that 45% of women with POP developed POSUI subjectively and objectively as well. [8][9][10] In a study ABSTRACT Background: Pelvic organ prolapse and stress urinary incontinence are two common health-related conditions. If a woman with pelvic organ prolapse leaks only when the prolapse is reduced, it is called occult stress urinary incontinence (OSUI). The prevalence of OSUI in women with severe genitourinary prolapse varies from 27-68% in literature. In this study we want to find out the relationship between OSUI and stress urinary incontinence (SUI) following corrective surgery.The objectives of the study are to determine the number of women with urinary leak following reduction of prolapse before surgery; to determine the number women with occult stress urinary incontinence developing stress urinary incontinence following surgery and to determine the risk of developing stress urinary incontinence after vaginal hysterectomy and pelvic floor repair in these women. Methods: This is a longitudinal observational study. All women with pelvic organ prolapse (POP) of grade II or higher requiring corrective surgery were initially evaluated for OSUI using vaginal pack and followed up post operatively at 6 weeks and 12 weeks using QUID to look for post-operative stress urinary incontinence (POSUI). Results:The overall incidence of OSUI in our study was 7.5%. OSUI was significantly associated with factors like older age, higher BMI, high parity, short inter pregnancy interval and higher grade of prolapse and not significantly associated with factors like place of delivery, delivery events and mode of delivery. Conclusions:It is important to test all women with POP for OSUI and patients with OSUI need long term follow up to detect POSUI

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“…2 Persson et al and Lensen et al also observed that increased BMI was a positively associated risk factor for the development of OSUI. 22,23 The same was observed in our study.…”

Section: Discussionsupporting

confidence: 91%

Study of occult stress urinary incontinence in pelvic organ prolapse

Reddy

Ghose

2017

Int J Reprod Contracept Obstet Gynecol

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“…2 Based on incontinence status, we defined the following patient groups that closely relate to clinical practice: (1) women with symptomatic coexisting SUI; (2) women asymptomatic for SUI (with or without occult SUI); and (3) women asymptomatic for SUI with occult SUI. We pooled the outcomes for the different anti-incontinence procedures, because they are equally effective in the treatment of SUI.…”

Section: Data Extractionmentioning

confidence: 99%

“…Earlier reviews and studies suggested the same, but evidence for this is still limited. 2,[46][47][48] It remains a problem that there is no consensus in diagnosing occult SUI, and different methods to detect occult SUI were used in the studies included in our review.…”

Section: Interpretation In the Light Of Other Evidencementioning

confidence: 99%

“…About 40-50% of the women with POP also report SUI before surgery, and these women are at highest risk to encounter SUI postoperatively. 1,2 Continent women can also develop SUI after surgery. [3][4][5] The risk is assumed to be highest (up to 80%) in the 20-30% of continent women with occult SUI, and is believed to be associated with kinking or compression of the urethra by the prolapse.…”

Section: Introductionmentioning

confidence: 99%

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Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

Ploeg

Steen

Rengerink

et al. 2014

BJOG

109

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Objectives The combination of prolapse surgery with an incontinence procedure can reduce the incidence of stress urinary incontinence (SUI) after surgery, but may increase adverse events. We compared the effectiveness and safety of prolapse surgery versus combined prolapse and incontinence surgery in women with pelvic organ prolapse.Design and setting Pubmed, EMBASE, DARE, the Cochrane Library and the register of Current Controlled Trials were searched for randomised trials (restricted to Burch colposuspension and midurethral sling as incontinence procedure) from 1995 to 2013 limited to the English literature.Methods Two reviewers selected eligible articles and extracted the data. Pooling for SUI was based on three patient groups: (1) women with coexisting SUI; (2) women asymptomatic for SUI; and (3) women with occult SUI. For adverse events, pooling was based on incontinence procedure.Main outcome measures The primary outcome was SUI. The secondary outcomes were treatment for SUI, bladder storage symptoms, obstructive voiding and adverse events.Results Seven trials were included. Pooling for women with coexisting SUI was possible for objective SUI with two studies and showed no difference. Statistical (I 2 = 95%) and clinical heterogeneity was, however, high. The largest study showed a lower incidence of persisting SUI (5% versus 23%) and treatment for this (0% versus 57%) in women who underwent prolapse repair with a midurethral sling. The second study did not find a difference in women undergoing a sacrocolpopexy with or without Burch colposuspension. In asymptomatic women, combination surgery resulted in a lower incidence of de novo subjective SUI (two studies; 24% versus 41%; relative risk [RR], 0.6; 95% confidence interval [CI], 0.3-0.9; I 2 = 36%) and the need for subsequent anti-incontinence surgery (three studies; 2% versus 7%; RR, 0.4; 95% CI, 0.2-0.8; I 2 = 13%). For the outcome objective SUI, pooling was possible for five studies, but statistical heterogeneity was high (I 2 = 82%) and the difference was not statistically significant. In the subgroup of women with occult stress incontinence, we found a lower incidence of objective SUI after combination surgery (two studies; 22% versus 52%; RR, 0.4; 95% CI, 0.3-0.8; I 2 = 32%). There were no differences in bladder storage symptoms, urgency incontinence or long-term obstructive voiding symptoms. Adverse events (two studies; 15% versus 10%; RR, 1.6; 95% CI, 1.0-2.5; I 2 = 0%) and prolonged catheterisation (three studies; 6% versus 1%; RR, 4.5; 95% CI, 1.5-13.3; I 2 = 0%)were more frequent after vaginal prolapse repair with a midurethral sling.Conclusions Combination surgery reduces the risk of postoperative stress incontinence, but short-term voiding difficulties and adverse events were more frequent after combination surgery with a midurethral sling.Keywords Burch colposuspension, meta-analysis, midurethral sling, pelvic organ prolapse, review, stress urinary incontinence.Please cite this paper as: van der Ploeg JM, van der Steen A, Oude Rengerink K, va...

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“…1 These women have increased risk to still experience SUI after prolapse repair. 2 When surgical correction of POP is indicated, there are two strategies to treat co-existing SUI: a one-step strategy (combined prolapse and incontinence surgery) or a two-step strategy (correct the prolapse first and evaluate incontinence afterwards). Evidence supporting the value of combination surgery is still limited in these women and two reviews recognised the need for further research.…”

Section: Introductionmentioning

confidence: 99%

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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Urinary incontinence after surgery for pelvic organ prolapse

Abstract: Preoperative SUI or UUI is the most important predictor of SUI and UUI postoperatively. BMI and COPD were identified as important risk factors for SUI.

Cited by 74 publications

References 27 publications

Study of occult stress urinary incontinence in pelvic organ prolapse

Study of occult stress urinary incontinence in pelvic organ prolapse

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

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

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