Comparison of Performing and Not-Performing the Prophylactic Surgery for Urinary Incontinence in Advanced Pelvic Organ Prolapse

Abstract

IntroductionPelvic prolapse is the downward and forward movement of a pelvic member towards its natural place and pelvic prolapse is displacement of the bladder, cervix, urethra, or rectum due to defects in pelvic support system. This condition is one of the most common abnormalities among older women. Urogenital prolapse is a common finding in 30% of women attending gynecologic of outpatient clinic (1-2) and affects up to 50% of women over 50 years (1,3). Up to 50% of women who had vaginal delivery suffer from degrees of prolapse, which is symptomatic only at the 20% of patients (4,5). In a study conducted in 1990 in America, it was reported that vaginal prolapse is the most common indication for hysterectomy in women over 50 (6). Urethral descent usually is seen with posterior and anterior wall of vagina/enterocele. Common symptoms include urinary frequency, urgency, incontinence, urinary increasing time of urination, feeling of incomplete emptying of the bladder and weak urinary flow. Posterior vaginal wall prolapse symptoms include disposal problems associated with prolonged excretion of urine, feeling of incomplete emptying of the bladder, constipation and fecal discharge with finger (1). Feeling of something coming down and sexual and urinary symptoms generally described as symptoms of prolapse especially in young women due to inadequacy of urethra (7). Most women with advanced anterior vaginal prolapse do not suffer from incontinency (1,8). Women who have severe pelvic prolapse may also have severe stress urinary incontinence (SUI). Reduction of prolapse during urodynamic assessments reveals non symptomatic cases of SUI in the 36 to 80% of women with advanced urogenital prolapse (1,9,10). Some recommend an anti-incontinency preventive procedure with prolapse restoration for prevention of post-operative urinary incontinence, but some do not recommend such a procedure (11)(12)(13)(14). For the First time in 1995 Ulmsten and Petros introduced a procedure to support the midsection of urethra without creating tension (15) providing a two-year cure rate of 84%. Since then this method which is named as tension free vaginal tape is used widely. Detayrace and colleagues reported 1 AbstractObjectives: To compare the Performing and not-performing of prophylactic surgery for urinary incontinence in women with pelvic organ prolapse. Materials and Methods: In a randomized controlled clinical trial that performed in department of Gynecology and Obstetrics of Tabriz University of Medical Sciences on women with advanced pelvic organ prolapse without history of urinary incontinence. The effects of performing and not-performing of prophylactic surgery for urinary incontinence in women with advance pelvic organ prolapse evaluated. Results: Mean age of patients was 53.83±5.52 years in the range of 41-66 years. Mean ICIQ-SF questionnaire scores at the first three questions in patients with pelvic organ prolapse with prophylactic surgery was 0.50±1.54 and in patients with pelvic organ prolapse without prophylactic surgery was 0...

Prolapse surgery with or without incontinence procedure: a systematic review and meta‐analysis

“…Appendix S3 summarizes the risk of bias of the trials and this is also added to the forest plots in the Supporting Information. Two studies were considered to be of high quality and two were assessed to be low‐quality trials . The other six trials were assessed to be of moderate quality.…”

“…Based on the abstract or full article, four were excluded because the subjects in the studies were not randomised . The publication by Bastani et al was included after communication with the authors clarifying their randomisation method, blinding and follow up. The selection of eight articles included four new trials, three publications with long‐term follow up from two previously included trials and one correction to an earlier publication .…”

“…The publication by Bastani et al was included after communication with the authors clarifying their randomisation method, blinding and follow up. The selection of eight articles included four new trials, three publications with long‐term follow up from two previously included trials and one correction to an earlier publication . We excluded one study from our earlier review, because we falsely included this as a quasi‐RCT, whereas it should have been considered a cohort .…”

“…We excluded one study from our earlier review, because we falsely included this as a quasi‐RCT, whereas it should have been considered a cohort . Adding the six trials from our earlier review, the updated review includes a total of ten RCTs (from 20 articles) …”

“…Three studies compared prolapse surgery with and without an incontinence procedure in women with coexisting symptomatic UI (Borstad and CUPIDO‐1 in vaginal prolapse repair with a MUS and Costantini in sacrocolpopexy with Burch colposuspension) . Seven RCTs studied combination surgery in symptomatically continent women: one trial did not test for occult SUI, the CARE and OPUS trial included women with or without occult SUI, three trials studied women with occult SUI and one included only women without occult SUI . Although the definition differed widely, all studies reported on (S)UI after surgery (see Table S1).…”