The Use of a Vaginal Pessary to Decide Whether a Mid Urethral Sling should be Added to Prolapse Surgery

Goessens, Emilie; Deriemaeker, Hanne; Cammu, Hendrik

doi:10.1097/ju.0000000000000575

Cited by 10 publications

(4 citation statements)

References 2 publications

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“…Women with POP and coexisting or occult SUI have the highest risk of postoperative SUI [7,16]; however, the predictive value of demonstrable SUI is limited and varies between studies [17,18]. According to some authors, the use of a vaginal pessary can help detect occult SUI and decide whether the insertion of a MUS should be done on top of the prolapse surgery [19], but in the opinion of others occult SUI detection rates depend on the technique applied and can significantly vary, from 6% with pessary prolapse reduction, to 16% with manual, to 30% when using a speculum [17].…”

Section: Discussionmentioning

confidence: 99%

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Horosz¹,

Pomian²,

Zwierzchowska³

et al. 2020

JCM

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Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.

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Section: Discussionmentioning

confidence: 99%

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Horosz¹,

Pomian²,

Zwierzchowska³

et al. 2020

JCM

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“…In women with prolapse and coexisting SUI, the literature indicates that vaginal prolapse repair should be combined with MUS in 2.5 women to prevent 1 woman needing subsequent MUS after prolapse surgery only (for example the number needed-to-treat (NNT) is 2.5) 4 . The NNT to prevent 1 woman from developing postoperative SUI using the universal approach varies from 6, to 3 to 9 4,8 , and for performing a selective procedure in women with occult SUI, the NNT is 3 4,30 . In a prospective cohort study, in patients with POP stage ≥ 3, MUCP<60 cmH 2 O and functional urethral length (FUL) <2 cm, the rate of postoperative SUI in the concomitant surgery group was 5% objectively and 10% subjectively, while in the POP surgery group it was 50% and 60%, respectively 31 .…”

Section: Sui Often Coexists With Popmentioning

confidence: 99%

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

Xia

et al. 2020

Preprint

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This retrospective cohort study aims to explore the clinical value of urodynamics in evaluating lower urinary tract function in pelvic organ prolapse (POP) patients, and to investigate the urodynamic characteristics of POP patients with occult stress urinary incontinence (OSUI) in whom moderate or above postoperative SUI eventually occurred after prolapse surgery. The medical records of 626 advanced POP patients who underwent vaginal pelvic reconstructive surgery were analyzed. The patients with anterior compartment prolapse were more susceptible to urodynamic changes than those with apical or posterior compartment prolapse (95.1% vs. 40.15%). The proportion of patients with urodynamic abnormality was increased with prolapse severity (68.8% vs. 78.6%). After 3 months, the incidence of moderate or severe postoperative urinary incontinence in the OSUI patients was 20%, while it is 2.8% in non-OSUI patients. In subgroup analysis of OSUI patients, the urodynamics of patients with moderate or above postoperative urinary leakage showed significantly lower Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), maximal bladder volume (MBV) and maximum urine flow rate (MUFR). For POP patients with OSUI, anti-incontinence surgery is only recommended for whom with lower VLPP, MUCP, MBV and MUFR to avoid the risk and costs of secondary surgery or overtreatment.

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“…In this retrospective study Goessens et al (page 598) from Belgium found that preoperative insertion of a pessary could help identify women at increased risk for SUI with prolapse surgery. 5 They calculated that in women who were continent with the pessary 11 mid urethral sling procedures would need to be performed to prevent post-prolapse surgery SUI in 1. Only 3 procedures would be required in women who had SUI with the pessary.…”

Section: Use Of Vaginal Pessary In Prolapse Surgerymentioning

confidence: 99%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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Patients should be involved in treatment decisions but it is often difficult for them to make an informed choice. Recognized experts may disagree, information on the internet can be suspect and physicians often incompletely suppress their own biases. Nowhere is this more true than in treatment of prostate cancer. Once a patient has decided on surgery, there are different surgical approaches to consider. A patient may come to regret a decision, especially if the outcome is different than expected.Baunacke et al (page 554) from Germany evaluated decision regret after radical prostatectomy in a cohort of 1,260 patients, and overall decision regret was low. 1 Erectile function, urinary continence and freedom from recurrence correlated with regret but surgical approach did not. An active role in decision making led to lower regret. The surgeon plays a highly influential role in informed consent and patients should be intimately involved in the process. A well informed patient is less likely to regret a decision even if things do not turn out completely as expected.

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The Use of a Vaginal Pessary to Decide Whether a Mid Urethral Sling should be Added to Prolapse Surgery

Cited by 10 publications

References 2 publications

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

This Month in Adult Urology

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