Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial

Abstract

Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.

Under what circumstances should stress incontinence surgery be performed at the same time as prolapse surgery? ICI‐RS 2015

“…Here, more complications were observed in the mid urethral sling group than in the control group (47% vs 17%; RR 2.73; 95%CI 1.35‐5.55). The difference was statistically significant in mild (26% vs 6%; RR 4.01; 95%CI 1.20‐13.41), but not in moderate (14% vs 6%) and severe (7% vs 4%) complications . Interestingly, in this multicentre study which also assessed quality of life, there was no significant difference between the groups, although 13% of women in the occult stress incontinence group who did not have a continence procedure, eventually needed a further continence procedure .…”

“…Therefore, Borstad et al assessed women in a randomized study with SUI, 3 months after prolapse repair and found 29% had no SUI, and a further 13% declined a tension free vaginal tape . However, a longer follow up of a year led to 52% of women having symptomatic SUI after prolapse surgery compared to only 14% of women who underwent a midurethral tape at the same time with a vaginal prolapse repair . The only other study by Costantini et al only involved 23 women in each arm although the follow‐up was 5 years .…”

The predictive value of demonstrable stress incontinence during basic office evaluation and urodynamics in women without symptomatic urinary incontinence undergoing vaginal prolapse surgery

“…Concurrent MUS insertion was also associated with a higher risk of postoperative voiding dysfunction (OR 3.1) . Although prolonged bladder catheterization and short term voiding dysfunction seems to be higher in women undergoing prolapse surgery with MUS compared to prolapse surgery only, there is strong evidence that long‐term voiding dysfunction is comparable …”

“…The CUPIDO‐1 trial aimed at women with prolapse and co‐existing SUI . In the CUPIDO‐2 trial continent women with occult SUI were randomized and women without occult SUI were followed in a parallel cohort . Women were included between 2007 and 2014 in 13 centers across the Netherlands.…”

“…Results are, however, difficult to compare due to differences in population (eg, baseline incontinence), tests to demonstrate SUI and consequently prevalence of demonstrable SUI, performed surgery and definition of postoperative SUI. Therefore, the positive predictive value of demonstrable SUI for predicting SUI after prolapse surgery varies tremendously between studies (0‐80%) and it remains questionable whether one should screen for demonstrable SUI . With respect to tests to demonstrate SUI, it is unclear if a stress test during basic office evaluation would be sufficient or if a stress test during urodynamic studies would be needed.…”