International Urogynecology Journal

, Volume 25, Issue 1, pp 33–40

Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial

  • Lore Schierlitz
  • Peter L. Dwyer
  • Anna Rosamilia
  • Alison De Souza
  • Christine Murray
  • Elizabeth Thomas
  • Richard Hiscock
  • Chahin Achtari
Original Article

Abstract

Introduction

We set out to determine if insertion of a retropubic tension-free vaginal tape (TVT) sling at the time of pelvic organ prolapse surgery improves continence outcomes in women with pre-operative occult stress incontinence (OSI) or asymptomatic urodynamic stress incontinence (USI).

Methods

We conducted a randomised controlled study of prolapse surgery with or without a TVT midurethral sling. The pre- and post-operative assessment at 6 months included history, physical examination and urodynamic testing. Quality of life (QOL) and treatment success was assessed with the UDI-6 SF, IIQ-7 SF and a numerical success score. The primary outcome was symptomatic stress urinary incontinence (SUI) requiring continence surgery (TVT) at 6 months. Long-term follow-up continued to a minimum of 24 months. Secondary outcomes were quality of life parameters.

Results

Eighty women received prolapse surgery alone (n = 43) or prolapse surgery with concurrent TVT (n = 37). Six months following prolapse surgery 3 out of 43 (7 %) patients in the no TVT group requested sling surgery compared with 0 out of 37 (0 %) in the TVT group (ARR 7 % [95 %CI: 3 to 19 %], p = 0.11). After 24 months there was one further participant in the no TVT group who received a TVT for treatment of SUI compared with none in the TVT group (4 out of 43, 9.3 % versus 0 out of 37; ARR 9.3 % [95 %CI: −1 to 22 %], p = 0.06). Both groups showed improvement in QOL difference scores for within-group analysis, without difference between groups.

Conclusion

These results support a policy that routine insertion of a sling in women with OSI at the time of prolapse repair is questionable and should be subject to shared decision-making between clinician and patient.

Keywords

Occult stress urinary incontinence Prolapse surgery Tension-free vaginal tape 

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Lore Schierlitz
    • 1
    • 2
  • Peter L. Dwyer
    • 1
  • Anna Rosamilia
    • 2
  • Alison De Souza
    • 1
  • Christine Murray
    • 1
  • Elizabeth Thomas
    • 1
  • Richard Hiscock
    • 1
  • Chahin Achtari
    • 1
    • 3
  1. 1.Department of UrogynaecologyMercy Hospital for WomenHeidelbergAustralia
  2. 2.Department of UrogynaecologyMonash Medical CentreClaytonAustralia
  3. 3.Department of Obstetrics and GynaecologyUniversity Hospital of Lausanne, Maternity-CHUVLausanneSwitzerland

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