International Urogynecology Journal

, Volume 24, Issue 11, pp 1843–1852 | Cite as

Pelvic organ prolapse surgery and bladder function

POP Surgery Review
First Online:

Abstract

Introduction and hypothesis

The aim was to determine the impact of pelvic organ prolapse surgery on bladder function.

Methods

Every 4 years, and as part of the Fifth International Collaboration on Incontinence we reviewed the English-langauage scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. Grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi processed expert opinion. Grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi.

Results

Continent women undergoing anterior compartment prolapse surgery have a lower rate of de novo stress urinary incontinence (SUI) after anterior repair than armed mesh procedures (grade A). Data are conflicting on whether colposuspension should be performed prophylactically in continent women undergoing sacral colpopexy (grade C). No clear conclusion can be made regarding the management of continent women undergoing prolapse surgery without occult SUI. In continent women undergoing POP surgery with occult SUI the addition of continence surgery reduces the rate of postoperative SUI (grade A). In women with prolapse and SUI symptoms prolapse procedures alone (transobturator mesh and anterior repair) are associated with low success rates for SUI. Concomitant continence procedures reduce the risk of postoperative SUI (grade B). Preoperative bladder overactivity may resolve in 40 % undergoing POP surgery and de novo bladder overactivity occurs in 12 %. No valid conclusions regarding voiding dysfunction following POP surgery can be drawn from the available data.

Conclusion

SUI and occult stress urinary incontinence should be treated at the time of prolapse surgery.

Keywords

Occult stress urinary incontinence Continence surgery Pelvic organ prolapse surgery 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This publication results from the work of the Committee on Pelvic Organ Prolapse Surgery, part of the 5th International Consultation on Incontinence, held in Paris in February 2012, under the auspices of the International Consultation on Urological Diseases, and enabled by the support of the European Association of Urology.

The authors wish to acknowledge the fine work of previous consultations led by Professor Linda Brubaker.

Conflicts of interest

None.

References

  1. 1.
    Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME (2009) The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1037–1045PubMedCrossRefGoogle Scholar
  2. 2.
    Reena C, Kekre AN, Kekre N (2007) Occult stress incontinence in women with pelvic organ prolapse. Int J Gynaecol Obstet 97(1):31–34PubMedCrossRefGoogle Scholar
  3. 3.
    Sinha D, Arunkalaivanan AS (2007) Prevalence of occult stress incontinence in continent women with severe genital prolapse. J Obstet Gynaecol 27(2):174–176PubMedCrossRefGoogle Scholar
  4. 4.
    Haessler AL, Lin LL, Ho MH, Betson LH, Bhatia NN (2005) Reevaluating occult incontinence. Curr Opin Obstet Gynecol 17(5):535–540PubMedCrossRefGoogle Scholar
  5. 5.
    Ellstrom Engh AM, Ekeryd A, Magnusson A, Olsson I, Otterlind L, Tobiasson G (2010) Can de novo stress incontinence after anterior wall repair be predicted? Acta Obstet Gynecol Scand 90(5):488–493CrossRefGoogle Scholar
  6. 6.
    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(5):607–614PubMedCrossRefGoogle Scholar
  7. 7.
    Chughtai B, Spettel S, Kurman J, De E (2011) Ambulatory pessary trial unmasks occult stress urinary incontinence. Obstet Gynecol Int 2012:392027PubMedGoogle Scholar
  8. 8.
    Romanzi LJ, Chaikin DC, Blaivas JG (1999) The effect of genital prolapse on voiding. J Urol 161(2):581–586PubMedCrossRefGoogle Scholar
  9. 9.
    Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014PubMedGoogle Scholar
  10. 10.
    Kenton K, Fitzgerald MP, Brubaker L (2005) Striated urethral sphincter activity does not alter urethral pressure during filling cystometry. Am J Obstet Gynecol 192(1):55–59PubMedCrossRefGoogle Scholar
  11. 11.
    Mueller ER, Kenton K, Mahajan S, FitzGerald MP, Brubaker L (2007) Urodynamic prolapse reduction alters urethral pressure but not filling or pressure flow parameters. J Urol 177(2):600–603PubMedCrossRefGoogle Scholar
  12. 12.
    Kasturi SDS, McDermott CD, Woodman PJ, Bump RC, Terry CL, Hale DS (2011) De novo stress urinary incontinence after negative prolapse reduction stress testing for total vaginal mesh procedures: incidence and risk factors. Am J Obstet Gynecol 205(5):487e1–487e4CrossRefGoogle Scholar
  13. 13.
    Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364(19):1826–1836PubMedCrossRefGoogle Scholar
  14. 14.
    Halaska M, Sottner O, Maxova K et al (2010) Prolene mesh comparing with sacrospinal fixation in the treatment of genital prolapse in women. Prospective multicentre randomized study. Ceska Gynekol 75(2):126–132PubMedGoogle Scholar
  15. 15.
    Ek M, Tegerstedt G, Falconer C et al (2010) Urodynamic assessment of anterior vaginal wall surgery: a randomized comparison between colporrhaphy and transvaginal mesh. Neurourol Urodyn 29(4):527–531PubMedGoogle Scholar
  16. 16.
    Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471PubMedCrossRefGoogle Scholar
  17. 17.
    Natale F, La Penna C, Padoa A, Agostini M, De Simone E, Cervigni M (2009) A prospective, randomized, controlled study comparing Gynemesh, a synthetic mesh, and Pelvicol, a biologic graft, in the surgical treatment of recurrent cystocele. Int Urogynecol J Pelvic Floor Dysfunct 20(1):75–81PubMedCrossRefGoogle Scholar
  18. 18.
    Hviid U, Hviid TV, Rudnicki M (2010) Porcine skin collagen implants for anterior vaginal wall prolapse: a randomised prospective controlled study. Int Urogynecol J Pelvic Floor Dysfunct 21(5):529–534CrossRefGoogle Scholar
  19. 19.
    Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanssen S (2010) Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 21(2):179–186CrossRefGoogle Scholar
  20. 20.
    Colombo M, Vitobello D, Proietti F, Milani R (2000) Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG 107(4):544–551PubMedCrossRefGoogle Scholar
  21. 21.
    Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky DBR, Sokol ER (2012) One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 206(1):86e1–86e9Google Scholar
  22. 22.
    Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117(2 Pt 1):242–250PubMedCrossRefGoogle Scholar
  23. 23.
    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
  24. 24.
    Nieminen K, Hiltunen R, Takala T et al (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203(3):235, e1-8PubMedCrossRefGoogle Scholar
  25. 25.
    Alcalay M, Cosson M, Livneh M, Lucot JP, Von Theobald P (2011) Trocarless system for mesh attachment in pelvic organ prolapse repair–1-year evaluation. Int Urogynecol J Pelvic Floor Dysfunct 22(5):551–556CrossRefGoogle Scholar
  26. 26.
    Ek M, Altman D, Falconer C, Kulseng-Hanssen S, Tegerstedt G (2010) Effects of anterior trocar guided transvaginal mesh surgery on lower urinary tract symptoms. Neurourol Urodyn 29(8):1419–1423PubMedCrossRefGoogle Scholar
  27. 27.
    Fayyad AM, North C, Reid FM, Smith AR (2011) Prospective study of anterior transobturator mesh kit (Prolift) for the management of recurrent anterior vaginal wall prolapse. Int Urogynecol J Pelvic Floor Dysfunct 22(2):157–163CrossRefGoogle Scholar
  28. 28.
    Feiner B, Gietelink L, Maher C (2010) Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct 21(2):203–208CrossRefGoogle Scholar
  29. 29.
    Groutz A, Chaikin DC, Theusen E, Blaivas JG (2001) Use of cadaveric solvent-dehydrated fascia lata for cystocele repair–preliminary results. Urology 58(2):179–183PubMedCrossRefGoogle Scholar
  30. 30.
    Takahashi S, Obinata D, Sakuma T et al (2010) Tension-free vaginal mesh procedure for pelvic organ prolapse: a single-center experience of 310 cases with 1-year follow up. Int J Urol 17(4):353–358PubMedCrossRefGoogle Scholar
  31. 31.
    Hiltunen R, Nieminen K, Takala T et al (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 110(2 Pt 2):455–462PubMedCrossRefGoogle Scholar
  32. 32.
    Hung MJ, Liu FS, Shen PS, Chen GD, Lin LY, Ho ES (2004) Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 15(6):399–406; discussionPubMedCrossRefGoogle Scholar
  33. 33.
    Sentilhes L, Sergent F, Resch B, Verspyck E, Descamps P, Marpeau L (2007) Midterm follow-up of high-grade genital prolapse repair by the trans-obturator and infracoccygeal hammock procedure after hysterectomy. Eur Urol 51(4):1065–1072PubMedCrossRefGoogle Scholar
  34. 34.
    Sergent F, Zanati J, Bisson V, Desilles N, Resch B, Marpeau L (2010) Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse. Int J Gynaecol Obstet 109(2):131–135PubMedCrossRefGoogle Scholar
  35. 35.
    Liang CC, Lin YH, Chang YL, Chang SD (2011) Urodynamic and clinical effects of transvaginal mesh repair for severe cystocele with and without urinary incontinence. Int J Gynaecol Obstet 112(3):182–186PubMedCrossRefGoogle Scholar
  36. 36.
    Kuribayashi M, Kitagawa Y, Narimoto K, Kawaguchi S, Konaka H, Namiki M (2011) Postoperative voiding function in patients undergoing tension-free vaginal mesh procedure for pelvic organ prolapse. Int Urogynecol J 22(10):1299–1303PubMedCrossRefGoogle Scholar
  37. 37.
    Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190(1):20–26PubMedCrossRefGoogle Scholar
  38. 38.
    Brubaker L, Cundiff GW, Fine P et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354(15):1557–1566PubMedCrossRefGoogle Scholar
  39. 39.
    Brubaker L, Nygaard I, Richter HE et al (2008) Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol 112(1):49–55PubMedCrossRefGoogle Scholar
  40. 40.
    Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2010) Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8-year followup. J Urol 185(6):2236–2240CrossRefGoogle Scholar
  41. 41.
    Costantini E, Zucchi A, Giannantoni A, Mearini L, Bini V, Porena M (2007) Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence? Eur Urol 51(3):788–794PubMedCrossRefGoogle Scholar
  42. 42.
    Sergent F, Gay-Crosier G, Bisson V, Resch B, Verspyck E, Marpeau L (2009) Ineffectiveness of associating a suburethral tape to a transobturator mesh for cystocele correction on concomitant stress urinary incontinence. Urology 74(4):765–770PubMedCrossRefGoogle Scholar
  43. 43.
    Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2008) Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. J Urol 180(3):1007–1012PubMedCrossRefGoogle Scholar
  44. 44.
    Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, Taylor AW (2007) A prospective randomised controlled study comparing vaginal prolapse repair with and without tension free vaginal tape (TVT) in women with severe pelvic organ prolapse and occult stress incontinence (Abstract number 114). Neurourol Urodyn 26(5):743–744Google Scholar
  45. 45.
    Wei JA (2011) Midurethral sling prevents incontinence among women undergoing vaginal prolapse repair—the OPUS trial (Abstract). Neurourol Urodyn 30 (S1):1–54Google Scholar
  46. 46.
    Maher CM, Feiner B, Baessler K, Glazener CM (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22(11):1445–1457PubMedCrossRefGoogle Scholar
  47. 47.
    Bump RC, Hurt WG, Theofrastous JP et al (1996) Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The continence program for women research group. Am J Obstet Gynecol 175(2):326–333, discussion 33–35PubMedCrossRefGoogle Scholar
  48. 48.
    Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R (1997) Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension. Am J Obstet Gynecol 176(2):337–343PubMedCrossRefGoogle Scholar
  49. 49.
    Colombo M, Maggioni A, Zanetta G, Vignali M, Milani R (1996) Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse. Obstet Gynecol 87(2):266–271PubMedCrossRefGoogle Scholar
  50. 50.
    Natale F, La Penna C, Padoa A, Panei M, Cervigni M (2008) High levator myorrhaphy for transvaginal suspension of the vaginal apex: long-term results. J Urol 180(5):2047–2052; discussion 52PubMedCrossRefGoogle Scholar
  51. 51.
    De Tayrac R, Mathe ML, Bader G, Deffieux X, Fazel A, Fernandez H (2008) Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse. Int J Gynaecol Obstet 100(2):154–159Google Scholar
  52. 52.
    Moore RD, Miklos JR (2009) Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year followup. Adv Urol 2009:743831Google Scholar
  53. 53.
    Foster RT Sr, Barber MD, Parasio MF, Walters MD, Weidner AC, Amundsen CL (2007) A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse. Am J Obstet Gynecol 197:82e1–82e4Google Scholar
  54. 54.
    Natale F, Mako A, Panei M, Weir J, Antomarchi F, Cervigni M (2007) Prospective randomized controlled study between two different procedures to suspend the vaginal vault: high levator myorrhaphy and uterosacral vaginal vault suspension (Abstract number 6). Neurourol Urodyn 26(5):608–609Google Scholar
  55. 55.
    Stekkinger E, van der Linden PJ (2011) A comparison of suprapubic and transurethral catheterization on postoperative urinary retention after vaginal prolapse repair: a randomized controlled trial. Gynecol Obstet Invest 72(2):109–116PubMedCrossRefGoogle Scholar
  56. 56.
    Meschia M, Pifarotti P, Bernasconi F, Magatti F, Riva D, Kocjancic E (2007) Porcine skin collagen implants to prevent anterior vaginal wall prolapse recurrence: a multicenter, randomized study. J Urol 177(1):192–195PubMedCrossRefGoogle Scholar
  57. 57.
    Gandhi S, Goldberg RP, Kwon C et al (2005) A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse. Am J Obstet Gynecol 192(5):1649–1654PubMedCrossRefGoogle Scholar
  58. 58.
    Withagen MI, Vierhout ME, Milani AL (2010) Does trocar-guided tension-free vaginal mesh (Prolift) repair provoke prolapse of the unaffected compartments? Int Urogynecol J 21(3):271–278PubMedCrossRefGoogle Scholar
  59. 59.
    Steinberg BJ, Finamore PS, Sastry DN, Holzberg AS, Caraballo R, Echols KT (2010) Postoperative urinary retention following vaginal mesh procedures for the treatment of pelvic organ prolapse. Int Urogynecol J 21(12):1491–1498PubMedCrossRefGoogle Scholar
  60. 60.
    Maher C, O’Rourke P (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117(6):1435–1436PubMedCrossRefGoogle Scholar
  61. 61.
    Feiner B, O’Rourke P, Maher C (2011) A prospective comparison of two commercial mesh kits in the management of anterior vaginal prolapse. Int Urogynecol J 23(3):279–283CrossRefGoogle Scholar
  62. 62.
    Hakvoort R, Roovers J (2011) Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG 119(1):115–116CrossRefGoogle Scholar
  63. 63.
    Huang CC, Ou CS, Yeh GP, Der Tsai H, Sun MJ (2010) Optimal duration of urinary catheterization after anterior colporrhaphy. Int Urogynecol J 22(4):485–491PubMedCrossRefGoogle Scholar
  64. 64.
    Weemhoff M, Wassen MM, Korsten L, Serroyen J, Kampschoer PH, Roumen FJ (2011) Postoperative catheterization after anterior colporrhaphy: 2 versus 5 days. A multicentre randomized controlled trial. Int Urogynecol J 22(4):477–483PubMedCrossRefGoogle Scholar
  65. 65.
    Ramanah R, Ballester M, Chereau E, Rouzier R, Darai E (2012) Effects of pelvic organ prolapse repair on urinary symptoms: a comparative study between the laparoscopic and vaginal approach. Neurourol Urodyn 31(1):26–31Google Scholar

Copyright information

© ICUD-EAU 2013

Authors and Affiliations

  1. 1.Charité University Hospital BerlinBerlinGermany
  2. 2.University of QueenslandRoyal Brisbane and Wesley UrogynaecologyBrisbaneAustralia

Personalised recommendations