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Evidence summaries

Surgery for Pelvic Organ Prolapse with Urinary Incontinence

Vaginal repair appears to be effective for pelvic organ prolapse in women with stress urinary incontinence (symptomatic or occult). A concurrent mid-urethral sling appears to reduce postoperative urinary incontinence. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and blinding in half of the studies).

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.

A population-based cohort study 2 assessed how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after surgery (n=2933). At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and urge UI with anterior compartment prolapse. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome urge UI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1-3%.

Clinical comments

Note

Date of latest search: 2025-02-06

    References

    • Baessler K, Christmann-Schmid C, Maher C et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev 2018;(8):CD013108. [PubMed]
    • Karjalainen PK, Tolppanen AM, Mattsson NK, et al. Pelvic organ prolapse surgery and overactive bladder symptoms-a population-based cohort (FINPOP). Int Urogynecol J 2022;33(1):95-105. [PubMed]

Primary/Secondary Keywords