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How Best to Manage the Urethra at the Time of Prolapse Correction

  • Stress Incontinence and Prolapse (R Dmochowski, Section Editor)
  • Published:
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Abstract

Pelvic organ prolapse usually is associated with urinary symptoms, especially urinary incontinence. In larger prolapses, the urethra tends to kink and produce mechanical urinary flow obstruction, leading to occult urinary incontinence. A high rate of women with occult urinary incontinence will present with symptoms after prolapse correction if an anti-incontinence procedure is not performed also. It is not yet clear whether both procedures should be performed together, because that approach increases the rate of complications. In our opinion, there is enough evidence to support combined surgery, at least in incontinent women and patients with occult incontinence; however, it is important to inform and advise women about the possible benefits and risks of each option for a joint decision to be made.

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References

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  1. Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function. Int Urogynecol J. 2013;24:1843–52. This is the result document of the Committee 15 “Surgical Management of Pelvic Organ Prolapse” from the 5th International Consultation on Incontinence held in Paris, February 2012.

    Article  PubMed  Google Scholar 

  2. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037–45.

    Article  Google Scholar 

  3. Mueller ER, Kenton K, Mahajan S, FitzGerald MP, Brubaker L. Urodynamic prolapse reduction alters urethral pressure but not filling or pressure flow parameters. J Urol. 2007;177(2):600–3.

    Article  CAS  PubMed  Google Scholar 

  4. Fatton B. Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? Int Urogynecol J. 2009;20:235–45.

    Article  CAS  Google Scholar 

  5. Nager CW, Tan-Kim J. Pelvic organ prolapse and stress urinary incontinence in women: combined surgical treatment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Last updated May 6, 2014).

  6. Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Richardson DA, Bent AE, Ostergard DR. The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol. 1983;146:901–5.

    CAS  PubMed  Google Scholar 

  8. Kleeman S, Vassallo B, Segal J, Hungler M, Karram M. The ability of history and a negative cough stress test to detect occult stress incontinence in patients undergoing surgical repair of advanced pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(1):27–9.

    Article  PubMed  Google Scholar 

  9. Schierlitz L, Dwyer PL, Rosamilia A, De Souza A, Murray C, Thomas E, et al. Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. Int Urogynecol J. 2014;25:33–40.

    Article  PubMed  Google Scholar 

  10. Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025–9.

    Article  PubMed  Google Scholar 

  12. Ballert KN, Biggs GY, Isenalumhe Jr A, Rosenblum N, Nitti VW. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. 2009;181(2):679–84.

    Article  PubMed  Google Scholar 

  13. Jelovsek JE, Chagin K, Brubaker L, Rogers RG, Richter HE, Arya L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:279–87.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Svenningsen R, Borstad E, Spydslaug AE, Sandvick L, Staff AC. Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery. Int Urogynecol J. 2012;23:843–9.

    Article  PubMed  Google Scholar 

  15. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014. To our knowledge, this is the only meta-analysis performed regarding urethral management and prolapse surgery, and it analyzes all the current evidence in this issue.

  16. Van der Ploeg JM, Van der Steen A, Oude Rengerink K, Van der Vaart CH, Roovers JP. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121(5):537–47.

    Article  PubMed  Google Scholar 

  17. Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanssen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(2):179–86.

    Article  Google Scholar 

  18. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, et al. Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112(1):49–55.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Constantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M. Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8-year follow-up. J Urol. 2010;185(6):2236–40.

    Article  Google Scholar 

  20. Lucas MG, Bedretdinova D, Bosch JLHR, Burkhard F, Cruz F, Nambiar AK, et al.; members of the European Association of Urology (EAU) Guidelines Office. Guidelines on urinary incontinence. EAU Guidelines, edition presented at the 29th EAU Annual Congress. Stockholm 2014

  21. Chang TC, Hsiao SM, Chen CH, Wu WY, Lin HH. Utilizing preoperative 20-minute pad testing with vaginal gauze packing for indicating concomitant midurethral sling during cystocele repair. Eur J Obstet Gynecol Reprod Biol. 2014;172:127–30.

    Article  PubMed  Google Scholar 

  22. Van der Steen A, Van der Ploeg M, Dijkgraaf MG, Van der Vaart H, Roovers JP. Protocol for the CUPIDO trials; multicenter randomized controlled trials to assess the value of combining prolapse surgery and incontinence surgery in patients with genital prolapse and evident stress incontinence (CUPIDO I) and in patients with genital prolapse and occult stress incontinence (CUPIDO II). BMC Womens Health. 2010;10:16.

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of Interest

Yanira Ortega González and María Antonia Pascual Amorós declare that they have no conflict of interest.

David Castro-Diaz has been Consultant, Investigator or speaker for the following organizations: Astellas, American Medical Systems, Allergan.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Urology, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain

    Yanira Ortega González

  2. Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain

    María Antonia Pascual Amorós

  3. Department of Urology, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain

    David Castro-Diaz

Authors
  1. Yanira Ortega González
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  2. María Antonia Pascual Amorós
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  3. David Castro-Diaz
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Corresponding author

Correspondence to Yanira Ortega González.

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This article is part of the Topical Collection on Stress Incontinence and Prolapse

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Ortega González, Y., Pascual Amorós, M.A. & Castro-Diaz, D. How Best to Manage the Urethra at the Time of Prolapse Correction. Curr Bladder Dysfunct Rep 10, 71–74 (2015). https://doi.org/10.1007/s11884-014-0274-3

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  • DOI: https://doi.org/10.1007/s11884-014-0274-3

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