Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview

Abstract

Postoperative SUI prevention at the time of prolapse surgery is still a challenging issue. Recent findings suggested that a systematic prophylactic Burch colposuspension could be performed in continent women undergoing a sacral colpopexy. The aim of this paper is to collect relevant literature in order to suggest a management strategy. A thorough PubMed research of all papers in the English language was conducted. Evidence-based medicine was analyzed and current unanswered questions were discussed. Despite evident limitations, it appears to be some benefit from preoperative screening with a stress test during prolapse reduction. In continent patient with a positive stress test, adding a preventive procedure could be fully justified. In regard to contradictory published data, when negative stress test, patient counseling is important and the ratio of risk-benefit should be rigorously discussed. Further randomized controlled studies are needed to support either a prophylactic or a second-step strategy.

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

“…Earlier reviews and studies suggested the same, but evidence for this is still limited. 2,[46][47][48] It remains a problem that there is no consensus in diagnosing occult SUI, and different methods to detect occult SUI were used in the studies included in our review.…”

Role of prophylactic midurethral sling in preventing post-operative stress urinary incontinence following repair of anterior vaginal wall prolapse

“…Their study utilized the transvaginal mesh in contrast to transobturator mesh which has a higher bladder perforation rate as reported by other authors. [13][14][15][16] Our study did not report any significant difference between the two groups for incidence of urinary tract infection (p=0.672). This was in contrast to the findings of the OPUS trial 18 where the difference was significant (p=0.008).…”

“…However, some authors advocate placement of a suburethral sling by systematic approach, taking into account the patients' variables and their own goals of therapy. [13][14][15][16] Several studies have been conducted to assess the benefits and effects of a prophylactic sling surgery. Various studies have evaluated this in the context of abdominal surgery, for example, Burch colposuspension 7,8 and vaginal procedures, such as, transvaginal tape [18][19][20][21] and transobturator tape 22 approach.…”

Trocar-guided polypropylene mesh for pelvic organ prolapse surgery—perioperative morbidity and short-term outcome of the first 100 patients

“…The anterior repair with mesh raises the risk for postoperative SUI from 10% to 23% compared to traditional colporraphy [14]. Antiincontinence operations in association with vaginal surgery are reportedly an efficient treatment of occult SUI [19], but the risk for urinary retention must be taken into consideration [20,21]. Therefore, although routine preoperative stress test might be positive, one must consider carefully whether concomitant SUI surgery is essential.…”