Objective: This retrospective review was conducted to assess whether the concomitant use of a tension-free sling (TVT) with minimally invasive sacrocolpopexy for the treatment of pelvic organ prolapse decreases postoperative stress urinary incontinence (SUI) in women with and without preoperative symptoms of stress incontinence.
Design: Women who reported symptoms of SUI and chose to undergo minimally invasive sacrocolpopexy received a concomitant retropubic tension-free sling, and women who did not report symptoms of SUI and who chose to undergo sacrocolpopexy to treat prolapse received a prophylactic concomitant mini-sling. These patients were compared with those that did not have a sling procedure and chose to proceed with a step approach. They were evaluated 3 months and 1 year after surgery. The primary outcomes included measures of stress incontinence (symptoms, stress testing, or treatment) and urge symptoms. Complications with the additional procedures were also tabulated.
Setting: University hospital, single-surgeon cases
Patients: Of 236 women who underwent minimally invasive sacrocolpopexy, 157 were symptomatic with SUI and 75 were not symptomatic with SUI. They are compared with 100 patients who underwent a prolapse repair without incontinence repair in the 2 years prior to this study.
Interventions: One hundred and fifty-seven symptomatic patients underwent a concomitant retropubic sling and 75 asymptomatic patients received a mini-sling.
Measurements and Main Results: One year after surgery, 6.4% of the women in the TVT group and 7.2% of the mini-sling group met 1 or more of the criteria for stress incontinence (p = 0.38). There was no significant difference between the TVT and the mini-sling group in the frequency of urge incontinence (12.7% versus 13.4%, p = 0.44). After surgery, women in both groups were less likely to report bothersome symptoms of stress incontinence compared to those reported previously in the literature (24.5% versus 6.7%, p < 0.001). Major sling complications included cystotomy (8.1%), infection (UTI) (15%), and catheter use for 2 days (12.6%).
Conclusions: In women with or without stress incontinence who were undergoing minimally invasive sacrocolpopexy for prolapse, a full or mini-sling significantly reduced postoperative symptoms of SUI without increasing complications or other lower urinary tract symptoms.
Lauren B Westermann, Jessika Kissling, Neena Agarwala
Date Received: January 26, 2012 Accepted on: March 20, 2012
KEYWORDS: sacracolpopexy, prolapse, SUI, sling, prophylaxis
CORRESPONDENCE: Neena Agarwala, MD, MSc, The Reading Hospital and Medical Center, Reading, Pennsylvania, United States (firstname.lastname@example.org).
CITATION: UroToday Int J. 2012 April;5(2):art 07. http://dx.doi.org/10.3834/uij.1944-5784.2012.04.13To read more, a FREE Urotoday registration is required. Click here to register or login above.