Abstract
Pelvic organ prolapse and stress urinary incontinence are two very common pelvic floor complaints in women. Many women choose definitive surgical treatment for bothersome prolapse; the number of women choosing this treatment option is projected to increase significantly by 2050. The literature is mixed in regards to management of occult stress urinary incontinence in patients undergoing prolapse repair. Various approaches to evaluation of occult stress urinary incontinence with prolapse reduction will be reviewed such as the universal, selective, and staged approaches. Informed consent that includes a thorough discussion of the options, risks, and benefits is paramount and allows the patient autonomy to choose the approach that is best for them individually.
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Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230. e1-5.
Slieker-ten Hove MC, Pool-Goudzwaard AL, Eiijkemans MJC, Steegers-Theuunissen RPM, Burger CW, Bierhout ME. 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. 2009;20:1037–45.
Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. 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. 2008;19:607–14.
Dunn JS, Bent AE, Ellerkman M, Nihira MA, Melick CF. Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J. 2004;15:25–3.
Haylen BT, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.
Van der Ploeg J, Oude Rengerink K, van der Steen A, van Leeuwen J, Stekelenburg J, Bongers M, et al. Transvaginal prolapse repair with and without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomized trial. BJOG. 2015;122:1022–30.
Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanseen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J. 2010;21:179–86.
Raman S, Raker CA, Sung VW. Concomitant apical prolapsed repair and incontinence procedures: trends from 2001-2009 in the US. Am J Obstet Gynecol. 2014;211–222:e1–5.
Haya N, Baessler K, Christmann-Schmid C, et al. Prolapse and continence surgery in countries of the Organization for Economic cooperation and Development in 2012. Am J Obstet Gynecol. 2015;755:e1–27.
Richardson DA, Bent AE, Ostergaard DR. The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol. 1983;146:901–5.
Bump RC, Fantl JA, Hurt WG. The mechanism of urinary incontinence in women with severe uterovaginal prolapsed: results of barrier studies. Obstet Gynecol. 1988;72:291–95.
Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, et al. Abdominal Sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354:1557–66.
Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, et al. Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112:49–55.
Nygaard I, Brubaker L, Zyczynski HM, Cundiff C, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.
Brubaker L, Cundiff G, Gine P, Nygaard I, Richter H, Visco A, et al. A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods. Control Clin Trials. 2003;24:629–42.
Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.
Wei J, Nygaard I, Richter H, Brown M, Barber M, Xiao X, et al. Outcomes following vaginal prolapsed repair and midurethral sling (OPUS) trial—design and methods. Clin Trials. 2009;6:162–71.
de Tayrac R, Gervaise A, Chauveaud-Lambling A, Fernandez H. Combined genital prolapse repair reinforced with a polypropylene mesh and tension-free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case-control study with short-term follow-up. Acta Obstet Gynecol Scand. 2004;83(10):950–4.
Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before SI surgery. NEJM. 2012;366:1987–97.
Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014.
Van der Pleoeg JM, Rengerink KO, Van Der Steen A, Schagen van Leeuwen JH, Van Der V, Roovers JPWR. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial. Int Urogynecology. 2016.
Constantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Prorena M. 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. 2011;185:2236–40. ** only study in which all women were completely dry preoperatively (no symptoms, no sign and no occult SUI and with longest f/u period of up to 8y).
Schierlitz L, Dwyer PL, Rosamilia A, De Souza A, Murray C, Thomas E, et al. Pelvic organ prolapsed surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomized controlled trial. Int Urogynecol. 2014;25:33–40.
Van der Ploeg JM, van der Steen A, Rengerrink KO, van der Vaart CH, Roovers JP. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomized trials. BJOG. 2014;121:537–47.
Constantini E, Lazzeri M, Bini V, Del Zingaro M, Frumenzio E, Porena M. 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. 2012 Article ID 967923.
Meschia M, Pifarotti P, Spennacchio M, Buonafuidi A, Gattei U, Somigliana E. A randomized comparison of tension-free vaginal tape and endopelvic fascia placation in women with genital prolapsed and occult stress urinary incontinence. Am J Obstet Gynecol. 2004;190:609–13.
Schierlitz L, Dwyer P, Rosamilla A, Murray C, Thomas E, Fitzgerald E, et al. A prospective randomized controlled trial comparing vaginal prolapse repair with and without tension-free vaginal tape (TVT) in women with severe genital prolapse and occult stress incontinence: long term follow up. Neurourol Urogyn. 2010;29:806–7.
Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR, et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):178–86.
Wang KH, Neimark M, et al. Voiding dysfunction following TVT procedure. Int Urogynecol J Pelvic Floor Dysfunc. 2002;13:353.
Segal JL, Vassallo B, Kleeman S, et al. Prevalence of persistent and de novo overactive bladder symptoms after the tension-free vaginal tape. Obstet GYnecol. 2004;104:1263.
Choe JH, Choo MS, Lee KS. The impact of tension-free vaginal tape on overactive bladder symptoms in women with SUI: significance of DO. J Urol. 2008;179:214.
Zacharakis D, Grigoriadis T, Kastanias S, Giannoulis G, Salvatore S, Athanasiou S. Occult stress urinary incontinence in women with pelvic organ prolapse: is the one step surgical approach a risky choice? Female Pelvic Med Reconstr Surg. 2015;00:00.
Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:279.
Oliphant SS, Shepherd JP, Lowder J. Midurethral sling for treatment of occult stress urinary incontinence at the time of colpocleisis: A Decision Analysis. Female Pelvic Med Reconstr Surg. 2012;18:4.
Jonsson Funk M, Siddiqui NY, Pate V, et al. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73.
Rardin CR, Rosenblatt PL, Kohli N, et al. Release of tension-free vaginal tape for the treatment of refractory postoperative voiding dysfunction. Obstet Gynecol. 2002;100:898.
Svenninsen R, Borstad E, Spydslaug AE, Sandvik L, Staff AE. Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapsed surgery. Int Urogynecol J. 2012;23:843–9.
Matsuoka PK, Pacetta AP, Baracat EC, Haddad JM. Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic Review. Int Urogynecol. 2015;26:187–93.
Richardson ML, Elliott CS, Shaw JG, Comiter CV, Chen B, Sokol ER. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol. 2013;190:1306–12.
Shepherd JP, Alperin M, Meyn LA, Frankman EA, Zyczynski HM. Now or later…Does timing of a midurethral sling in relation to transvaginal prolapse repair affect incontinence outcomes at 1 year? Female Pelvic Med Reconstr Surg. 2010;16:5. 299-303.
Liapis A, Bakas P, Georgantopoulou C, Creatsas G. The use of the pessary test in preoperative assessment of women with severe genital prolapse. Eur J Obstet Gynecol Reprod Biol. 2011;155(1):110–3.
Ghoniem G, Hammett J. Female pelvic medicine and reconstructive surgery practice patterns: IUGA member survey. Int Urogynecol J. 2015;26:1489–94.
Ballert KN, Biggs GY, Isenalumhe Jr A, et al. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. 2009;181:679.
Chermansky CJ, Krlin RM, Winters C. Selective management of the urethra at time of pelvic organ prolapse repair: an assessment of postoperative incontinence and patient satisfaction. J Urol. 2012;187:2144–8.
Chaikin DC, Groutz A, Blavias JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163:531.
Liang CC, Chang YL, Chang SD, Lo TS, Soong YK. Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol. 2004;104(4):795–800.
Jundt K, Wagner S, von Bodungen V, Friese K. Peschers UM Occult incontinence in women with pelvic organ prolapse—does it matter? Eur J Med Res. 2010;15(3):112–6.
Ennemoser S, Schönfeld M, von Bodungen V, Dian D, Friese K, Jundt K. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J. 2012;23(7):851–5.
Lo TS, Karim N, Nawawi EA, Wu PY, Nusee Z. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogyncol J. 2015;26:1313–9.
Lensen EJM, Withagen M, Kluivers KB, Milani AL, Vierhout ME. Urinary Incontinence after surgery for pelvic organ prolapse. Neurourol Urodyn. 2013;32:455.
Mahajan ST, Elkadry EA, Kenton KS, Shott S, Brubaker L. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol. 2006;194:722–8.
Elkadry EA, Kenton KS, Fitzgerald MP, Shott S, Brubaker L. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189:1551–7. discussion 1557-1558.
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Alexis Tran, Carolyn Botros, and Sylvia M. Botros declare that they have no conflict of interest.
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Tran, A., Botros, C. & Botros, S.M. Concomitant Incontinence Surgery at the Time of Prolapse Repair. Curr Obstet Gynecol Rep 5, 139–146 (2016). https://doi.org/10.1007/s13669-016-0159-x
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DOI: https://doi.org/10.1007/s13669-016-0159-x