International Urogynecology Journal

, Volume 23, Issue 7, pp 827–829 | Cite as

Women with occult stress incontinence should not routinely have a mid-urethral sling with prolapse surgery

  • Peter L. Dwyer
Clinical Opinion


The risk of postoperative stress incontinence (SI) is increased in women with occult stress incontinence (OSI) but the majority of patients will not develop troublesome SI postoperatively or need further SI surgery. This risk reported in current studies does not warrant a mid-urethral sling at the time of surgery for pelvic organ prolapse in women with OSI. However, if performed, the risks as well as the benefits need to be discussed with the patient.


Occult stress incontinence Mid-urethral sling Pelvic organ prolapse 


Conflicts of interest



  1. 1.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRefGoogle Scholar
  2. 2.
    Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, Taylor N, Hiscock R, Lim Y, Achtari A, DeSouza A (2010) A prospective randomised controlled study comparing vaginal prolapse repair with and without Tension free Vaginal Tape (TVT) in women with severe genital prolapse and occult stress incontinence; 3 year follow up. Int Urogynecol J 21(Suppl 1):S2Google Scholar
  3. 3.
    Jha S, Moran PA (2007) National survey on the management of prolapse in the UK. Neurourol Urodyn 26:325–331PubMedCrossRefGoogle Scholar
  4. 4.
    Vanspauwen R, Semen E, Dwyer PL (2010) Survey of current management of prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol 50(3):262–267PubMedCrossRefGoogle Scholar
  5. 5.
    Visco AG, Brubaker L, Nygaard I et al (2008) 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 19:607–614PubMedCrossRefGoogle Scholar
  6. 6.
    Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter P (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190:20–26PubMedCrossRefGoogle Scholar
  7. 7.
    Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, Zyczynski H, Brown MB, Weber AM (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354(15):1557–1566PubMedCrossRefGoogle Scholar
  8. 8.
    Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, Fine P, Ghetti C, Brown MB (2008) Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol 112(1):49–55PubMedCrossRefGoogle Scholar
  9. 9.
    Wiskind AK, Creighton SM, Stanton SL (1992) The incidence of genital prolapse after the Burch colposuspension. Am J Obstet Gynecol 167(2):399–404PubMedGoogle Scholar
  10. 10.
    Meschia M, Pifarotti P, Spennacchio M, Buonaguidi A, Gattei U, Somigliana E (2004) A randomized comparison of tension-free vaginal tape and endopelvic fascia plication in women with genital prolapse and occult stress urinary incontinence. Am J Obstet Gynecol 190(3):609–613PubMedCrossRefGoogle Scholar
  11. 11.
    Wei J (2011) A mid urethral sling prevents incontinence among women undergoing vaginal prolapse repair–the OPUS trial. Neurourol Urodyn 30:809–811Google Scholar
  12. 12.
    Schraffordt Koops S, Bisseling TM, Heintz PM, Vervest HA (2005) Prospective analysis of complications of tension-free vaginal tape from The Netherlands Tension-free Vaginal Tape study. Am J Obstet Gynecol 193:45–52PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  1. 1.Department of UrogynecologyMercy Hospital for Women, University of MelbourneMelbourneAustralia

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