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Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence

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Abstract

Introduction and hypothesis

This study aims to compare the result of an incontinence procedure performed at the time of prolapse repair or 3 months later in women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI).

Methods

In a multicenter prospective randomized trial, women with POP and SUI were randomized to have a tension-free vaginal tape (TVT) at the time of prolapse repair (n = 87; group I) or 3 months later (n = 94; group II). Women in group II were evaluated for SUI 3 months after the prolapse repair. Those with confirmed SUI had a TVT performed (n = 53). The main evaluation of all women was 1 year after the last surgery.

Results

On-treatment analysis resulted in 95% cure of SUI in group I and 89% in group II (p = 0.12). Twenty-seven percent were cured after prolapse surgery alone.

Conclusions

No differences were found between the two treatment strategies, but almost one third of women were cured of SUI by prolapse surgery alone.

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References

  1. Versi E, Lyell DJ, Griffiths DJ (1998) Videourodynamic diagnosis of occult genuine stress incontinence in patients with anterior vaginal wall relaxation. J Soc Gynecol Investig 5:327–330

    Article  CAS  PubMed  Google Scholar 

  2. Veronikis DK, Nichols DH, Wakamatsu MM (1997) The incidence of low-pressure urethra as a function of prolapse-reducing technique in patients with massive pelvic organ prolapse (maximum descent at all vaginal sites). Am J Obstet Gynecol 177:1305–1313

    Article  CAS  PubMed  Google Scholar 

  3. Hilton P, Dolan LM (2004) Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG 111(Suppl 1):5–9

    PubMed  Google Scholar 

  4. Bai SW, Jeon MJ, Kim JY, Chung KA, Kim SK, Park KH (2002) Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 13:256–260

    Article  CAS  PubMed  Google Scholar 

  5. Bai SW, Kang SH, Kim SK, Kim JY, Park KH (2003) The effect of pelvic organ prolapse on lower urinary tract function. Yonsei Med J 44:94–98

    PubMed  Google Scholar 

  6. Chen B, Wen Y, Polan ML (2004) Elastolytic activity in women with stress urinary incontinence and pelvic organ prolapse. Neurourol Urodyn 23:119–126

    Article  PubMed  Google Scholar 

  7. Dietz HP, Hansell NK, Grace ME, Eldridge AM, Clarke B, Martin NG (2005) Bladder neck mobility is a heritable trait. BJOG 112:334–339

    Article  CAS  PubMed  Google Scholar 

  8. Jorgensen L, Lose G, Molsted-Pedersen L (1987) Vaginal repair in female motor urge incontinence. Eur Urol 13:382–385

    CAS  PubMed  Google Scholar 

  9. Coates KW, Harris RL, Cundiff GW, Bump RC (1997) Uroflowmetry in women with urinary incontinence and pelvic organ prolapse. Br J Urol 80:217–221

    CAS  PubMed  Google Scholar 

  10. Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF 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 175:326–333

    Article  CAS  PubMed  Google Scholar 

  11. Borstad E, Rud T (1989) The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 68:545–549

    Article  CAS  PubMed  Google Scholar 

  12. Borstad E, Skrede M, Rud T (1991) Failure to predict and attempts to explain urinary stress incontinence following vaginal repair in continent women by using a modified lateral urethrocystography. Acta Obstet Gynecol Scand 70:501–506

    Article  CAS  PubMed  Google Scholar 

  13. Liang CC, Chang YL, Chang SD, Lo TS, Soong YK (2004) Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol 104:795–800

    PubMed  Google Scholar 

  14. Romanzi LJ (2002) Management of the urethral outlet in patients with severe prolapse. Curr Opin Urol 12:339–344

    Article  PubMed  Google Scholar 

  15. Tapp K, Connolly A, Visco AG (2005) Evaluation of Aa point and cotton-tipped swab test as predictors of urodynamic stress incontinence. Obstet Gynecol 105:115–119

    PubMed  Google Scholar 

  16. Drutz HP, Alnaif B (1998) Surgical management of pelvic organ prolapse and stress urinary incontinence. Clin Obstet Gynecol 41:786–793

    Article  CAS  PubMed  Google Scholar 

  17. Amundsen CL, Flynn BJ, Webster GD (2003) Anatomical correction of vaginal vault prolapse by uterosacral ligament fixation in women who also require a pubovaginal sling. J Urol 169:1770–1774

    Article  PubMed  Google Scholar 

  18. Huang KH, Kung FT, Liang HM, Chen CW, Chang SY, Hwang LL (2006) Concomitant pelvic organ prolapse surgery with TVT procedure. Int Urogynecol J Pelvic Floor Dysfunct 17:60–65

    Article  PubMed  Google Scholar 

  19. FitzGerald MP, Brubaker L (2003) Colpocleisis and urinary incontinence. Am J Obstet Gynecol 189:1241–1244

    Article  PubMed  Google Scholar 

  20. Sze EH, Miklos JR, Partoll L, Roat TW, Karram MM (1997) Sacrospinous ligament fixation with transvaginal needle suspension for advanced pelvic organ prolapse and stress incontinence. Obstet Gynecol 89:94–96

    Article  CAS  PubMed  Google Scholar 

  21. Kulseng-Hanssen S, Borstad E (2002) Comparison of subjective and objective outcome values and complication rate after TVT operations exclusively and TVT operation and vaginal repair for prolapse combined. IUGA. Int Urogynecol J Pelvic Floor Dysfunct 13(suppl 1):S33

    Google Scholar 

  22. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  CAS  PubMed  Google Scholar 

  23. Kulseng-Hanssen S (2003) The development of a national database of the results of surgery for urinary incontinence in women. BJOG 110:975–982

    Article  PubMed  Google Scholar 

  24. Kuuva N, Nilsson CG (2006) Long-term results of the tension-free vaginal tape operation in an unselected group of 129 stress incontinent women. Acta Obstet Gynecol Scand 85:482–487

    Article  PubMed  Google Scholar 

  25. Nilsson CG, Falconer C, Rezapour M (2004) Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 104:1259–1262

    PubMed  Google Scholar 

  26. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P (2008) Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309

    PubMed  Google Scholar 

  27. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 1:2

    Article  CAS  PubMed  Google Scholar 

  28. Bai SW, Cho JM, Kwon HS, Park JH, Shin JS, Kim SK et al (2005) The relationship between maximal urethral closure pressure and functional urethral length in anterior vaginal wall prolapse patients according to stage and age. Yonsei Med J 46:408–413

    PubMed  Google Scholar 

  29. Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354:1557–1566

    Article  CAS  PubMed  Google Scholar 

  30. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW et al (2008) Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol 112:49–55

    PubMed  Google Scholar 

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Acknowledgement

We are grateful to all the gynecologists from the six other hospitals who have been responsible for the inclusion and evaluation of patients in their respective hospitals: Kajomars Mogimi, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim; Margrete Sandved, Asker and Baerum Hospital, Akershus; Memona Majida, Department of Obstetrics and Gynecology, Akershus University Hospital, Akershus; Kari Western, Department of Obstetrics and Gynecology, Oestfold Central Hospital, Fredrikstad; Erik Rokkones, Department of Obstetrics and Gynecology, Rikshospitalet, Oslo; and Anne Grethe Paulsen, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen; all Norway.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Oslo University Hospital, Ulleval, 0407, Oslo, Norway

    Ellen Borstad & Anne Cathrine Staff

  2. Center for Clinical Research, Oslo University Hospital, Ulleval, Oslo, Norway

    Michael Abdelnoor

  3. Faculty of Medicine, University of Oslo, Oslo, Norway

    Anne Cathrine Staff

  4. Department of Obstetrics and Gynecology, Baerum Central Hospital, Akershus, Norway

    Sigurd Kulseng-Hanssen

Authors
  1. Ellen Borstad
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  2. Michael Abdelnoor
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  3. Anne Cathrine Staff
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  4. Sigurd Kulseng-Hanssen
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Corresponding author

Correspondence to Ellen Borstad.

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Borstad, E., Abdelnoor, M., Staff, A.C. et al. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J 21, 179–186 (2010). https://doi.org/10.1007/s00192-009-1007-6

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  • DOI: https://doi.org/10.1007/s00192-009-1007-6

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