Surgery for Pelvic Organ Prolapse with Stress Urinary Incontinence

Summary

A Cochrane review [Abstract] 1 included 19 studies with a total of 2717 subjects. Pelvic organ prolapse (POP) is common in women and is frequently associated with stress urinary incontinence (SUI). However, SUI may be present only with the prolapse reduced (occult SUI) or may develop after surgical treatment for prolapse (de novo SUI).

Vaginal repair with vs without concomitant mid-urethral sling (MUS): A concomitant sling decreased postoperative rates of subjective stress urinary incontinence (RR 0.30, 95% CI 0.19 to 0.48; 2 trials, n=319) and need for further continence surgery (RR 0.04, 95% CI 0.00 to 0.74; 1 trial, n=134). This suggests that if the risk of SUI with prolapse surgery alone is 39%, the risk with surgery and sling is between 8% and 19%.

Abdominal sacrocolpopexy with vs without Burch colposuspension: An additional Burch colposuspension had little or no effect on postoperative SUI at one year (RR 1.38, 95% CI 0.74 to 2.60; 1 trial, n=47, overactive bladder symptoms (RR 0.85, 95% CI 0.61 to 1.18; 1 trial, n=33), or voiding dysfunction (RR 0.96, 95% CI 0.06 to 14.43; 1 trial, n=47).

Vaginal repair with vs without concomitant mid-urethral sling in women with occult SUI: Sling improved rates of subjective postoperative SUI (RR 0.38, 95% CI 0.26 to 0.55; 5 trials, n=369). This suggests that if the risk with surgery alone is 34%, the risk with a concomitant sling is between 10% and 22%. The need for further surgery was not reported.