Despite the preoperative evidence of OSUI, the manifestation of SUI rarely occurs, with 28.1 % of patients experiencing SUI over long-term follow-up after vaginal prolapse surgery. Anti-incontinence surgery was necessary in only three cases (5.3 %). These results indicate that with the one-step approach, 54 of 57 patients (94.7 %) would have received prophylactic anti-incontinence surgery unnecessarily. In conclusion, we recommend the two-step approach in the management of vaginal prolapse surgery in patients with OSUI.

A sequential neoadjuvant chemo-/radiotherapy to allow IBR following mastectomy in selected cases of LABC seems feasible and can be safely attempted. Careful patient selection, close monitoring, and continuous patient support is mandatory to ensure compliance in this treatment strategy.

ObjectiveMany surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery.Methods233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed.Results19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape.ConclusionThe incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.

No abstract

In conclusion, prophylactic mastectomy and breast reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via transmammary access is feasible, easy to perform and provides an intriguing and novel approach to female BRCA carriers who desire operative prophylactic measures in one surgical session with no visible abdominal scars and no additional risks and complications.