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Stress incontinence surgery at the time of prolapse surgery: Mandatory or forbidden?

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Abstract

Introduction

Concomitant anti-incontinence surgery at the time of prolapse repair has been a long-debated topic. Still today, there remains no clear answer to this question, although in recent years the literature has become more robust with the addition of more randomized controlled trials. The lifetime risk for women of undergoing surgical correction of pelvic organ prolapse is significant, and concomitant anti-incontinence surgery is an important question during surgical planning.

Materials and methods

This review delves further into the current literature to discuss a possible algorithm for managing the risk of stress incontinence after pelvic organ prolapse repair and examines the support in the literature for the following treatment methods: (1) anti-incontinence surgery for all women undergoing pelvic organ prolapse repair, (2) anti-incontinence surgery for no women undergoing pelvic organ prolapse repair, and (3) anti-incontinence surgery in select women undergoing pelvic organ prolapse repair.

Conclusions

While there are data both for and against each of these approaches, after a review of the literature, we recommend anti-incontinence surgery for select women undergoing pelvic organ prolapse repair, including women with a history of symptomatic and occult stress incontinence diagnosed preoperatively.

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References

  1. Dmochowski R, Blaivas J, Gormley EA, Juma S, Karram M, Lightner D, Luber K, Rovner E, Staskin D, Winters JC, Appell RA (2010) Update of AUA guidelines on the surgical management of female stress urinary incontinence. J Urol 183:1906–1914

    Article  PubMed  Google Scholar 

  2. Wu J, Matthews C, Conover M, Pate V, Funk M (2014) Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 123:1201–1206

    Article  PubMed Central  PubMed  Google Scholar 

  3. Grody MH (1998) Urinary incontinence and concomitant prolapse. Clin Obstet Gynecol 41:777–785

    Article  CAS  PubMed  Google Scholar 

  4. Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanseen S (2010) Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J 21:179–186

    Article  PubMed  Google Scholar 

  5. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014

    PubMed  Google Scholar 

  6. Haylen BT, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, Monga A, Petri E, Rizk D, Sand P, Schaer G (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26

    Article  PubMed  Google Scholar 

  7. Reena C, Kekre AN, Kekre N (2007) Occult stress incontinence in women with pelvic organ prolapse. Int J Gynecol Obstet 97:31–34

    Article  CAS  Google Scholar 

  8. Brubaker L, Cundiff G, Fine P, Nygaard I, Richter H, Visco A, Zyczynski H, Brown M, Weber A (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. NEJM 354:1557–1566

    Article  CAS  PubMed  Google Scholar 

  9. Wei J, Nygaard I, Richter H, Nager C, Barber M, Kenton K, Amundsen C, Schaffer J, Meikle S, Spino C (2012) A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 366:2358–2367

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Casiano E, Gebhart J, McGree M, Weaver A, Klingele C, Trabuco E (2011) Does concomitant prolapse repair at the time of midurethral sling affect recurrent rates of incontinence? Int Urogynecol J 22:819–825

    Article  PubMed  Google Scholar 

  11. Ballert K, Biggs G, Isenalumhe A, Rosenblum N, Nitti V (2009) Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol 181:679–684

    Article  PubMed  Google Scholar 

  12. Nygaard I, Brubaker L, Zyczynski H, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren L, Zhang M, Meikle S (2013) Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 309:2016–2024

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Van Der Ploeg JM, Der Van, Steen A, Oude Rengerink K, Van Der Vaart CH, Roovers JP (2014) Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomized trials. BJOG 121:537–547

    Article  PubMed  Google Scholar 

  14. 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 112:49–55

    Article  PubMed Central  PubMed  Google Scholar 

  15. Barber M, Kleeman S, Karram M, Paraiso MF, Walters MD, Vasavada S, Ellerkmann M (2008) Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 111:611–621

    Article  PubMed  Google Scholar 

  16. Richardson M, Elliott C, Shaw J, Comiter C, Chen B, Sokol E (2013) To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol 190:1306–1312

    Article  PubMed  Google Scholar 

  17. Ennemoser S, Schonfeld M, von Bodungen V et al (2012) Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J 23:851–855

    Article  PubMed  Google Scholar 

  18. Liapis A, Bakas P, Georgantopoulou C, Creatsas G (2011) The use of the pessary test in preoperative assessment of women with severe genital prolapse. Eur J Obstet Gynecol Reprod Biol 155:110–113

    Article  CAS  PubMed  Google Scholar 

  19. Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2011) 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 185:2236–2240

    Article  PubMed  Google Scholar 

  20. Costantini E, Lazzeri M, Bini V, Del Zingaro M, Frumenzio E, Porena M (2011) Pelvic organ prolapse repair with and without concomitant Burch colposuspension in incontinent women: a randomized, controlled trial with at least 5-year follow up. Obstet Gynecol Int 2012 Article ID 967923

  21. Schierlitz L, Dwyer P, Rosamilia A, de Souza A, Murray C, Thomas E, Hiscock R, Achtari C (2014) Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomized controlled trial. Int Urogynecol J 25:33–40

    Article  PubMed  Google Scholar 

  22. 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 19:607–614

    Article  PubMed Central  PubMed  Google Scholar 

  23. Jelovsek JE, Chagin K, Brubaker L, Rogers R, Richter H et al (2014) A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol 123:279–287

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wolters J, King A, Rapp D (2014) Satisfaction in patients undergoing concurrent pelvic floor surgery for stress urinary incontinence and pelvic organ prolapse. FPMRS 20:23–26

    Google Scholar 

  25. Sand PK, Sumana K, Lobel R et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1364

    Article  CAS  PubMed  Google Scholar 

  26. Gandhi S, Goldberg R, 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 192:1649–1654

    Article  PubMed  Google Scholar 

  27. Goldberg R, Koduri S, Lobel R et al (2001) Protective effect of suburethral slings on postoperative cystocele recurrence after reconstructive pelvic operation. Am J Obstet Gynecol 185:1307–1313

    Article  CAS  PubMed  Google Scholar 

  28. Kohli N, Sze E, Roat T, Karram M (1996) Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension. Am J Obstet Gynecol 175:1476–1480

    Article  CAS  PubMed  Google Scholar 

  29. Chermansky C, Krlin R, Winters C (2012) Selective management of the urethra at time of pelvic organ prolapse repair: an assessment of postoperative incontinence and patient satisfaction. J Urol 187:2144–2148

    Article  PubMed  Google Scholar 

  30. Wei J, Nygaard I, Richter H, Brown M, Barber M, Xu X, Kenton K, Nager C, Schaffer J, Visco A, Weber A (2009) Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial—design and methods. Clin Trials 6:162–171

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

The authors claim no direct conflict of interest; however, one author (HBG) does have financial relationships with Medtronic, Allergan, and Uroplasty.

Ethical standard

As a review paper, this is exempt from IRB review.

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Correspondence to Ashley B. King.

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King, A.B., Goldman, H.B. Stress incontinence surgery at the time of prolapse surgery: Mandatory or forbidden?. World J Urol 33, 1257–1262 (2015). https://doi.org/10.1007/s00345-015-1591-7

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  • DOI: https://doi.org/10.1007/s00345-015-1591-7

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