Pelvic organ prolapse surgery and bladder function
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Introduction and hypothesis
The aim was to determine the impact of pelvic organ prolapse surgery on bladder function.
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.
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.
SUI and occult stress urinary incontinence should be treated at the time of prolapse surgery.
KeywordsOccult stress urinary incontinence Continence surgery Pelvic organ prolapse surgery
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
- 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
- 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
- 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
- 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
- 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
- 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.Wei JA (2011) Midurethral sling prevents incontinence among women undergoing vaginal prolapse repair—the OPUS trial (Abstract). Neurourol Urodyn 30 (S1):1–54Google Scholar
- 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
- 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.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.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.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
- 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