Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Abstract

Objective To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only.Design Multi-centre randomised trial.Setting Fourteen teaching hospitals in the Netherlands.Population Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction.Methods Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat.Main outcome measures The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications.Results One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54).Conclusions Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A wellinformed decision balancing risks and benefits of both strategies should be tailored to individual women.Keywords Midurethral sling, pelvic organ prolapse, randomised, stress urinary incontinence.Tweetable abstract Combination of prolapse repair with midurethral sling reduces the risk of postoperative stress incontinence.Please cite this paper as: van der Ploeg JM, Oude Rengerink K, van der Steen A, van Leeuwen JHS, Stekelenburg J, Bongers MY, Weemhoff M, Mol BW, van der Vaart CH, Roovers J-PWR, on behalf of the Dutch Urogynaecology Consortium*. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG 2015;122:1022-1030.*The complete list of authors and collaborators from the Dutch Urogynaecology Consortium are listed in Supporting Information Appendix S1.Trial registration: The Netherlands National Trial Register NTR1197 (www.trialregister.nl).

The effectiveness of a pre-pubic four-arm NAZCA-TC mesh in treating cystocele and stress urinary incontinence simultaneously — results controlled with a pelvic floor ultrasound. A preliminary study

“…Yet, compared to anterior mesh procedure where 39--77% of women became free of SUI symptoms, combining anterior mesh with a suburethral tape implantation gave a 78-95% cure rate. However, the incidence of complications was significantly higher after a combined procedure [13,34].…”

“…journals.viamedica.pl/ginekologia_polska dure or not. While occult incontinence may coexist in up to 30% of women with POP, about 40-50% of women with POP observe a significant SUI [12,13]. NAZCA-TC is a mesh with four arms: two pre-pubic and two transobturator.…”

The predictive value of demonstrable stress incontinence during basic office evaluation and urodynamics in women without symptomatic urinary incontinence undergoing vaginal prolapse surgery

“…Concurrent MUS insertion was also associated with a higher risk of postoperative voiding dysfunction (OR 3.1) . Although prolonged bladder catheterization and short term voiding dysfunction seems to be higher in women undergoing prolapse surgery with MUS compared to prolapse surgery only, there is strong evidence that long‐term voiding dysfunction is comparable …”

“…This study used data from CUPIDO‐1 (NTR 1197) and CUPIDO‐2 (NTR 1070), two multicenter randomized trials that compared postoperative SUI in vaginal prolapse repair with and without midurethral sling (MUS) . The CUPIDO‐1 trial aimed at women with prolapse and co‐existing SUI . In the CUPIDO‐2 trial continent women with occult SUI were randomized and women without occult SUI were followed in a parallel cohort .…”

Re: Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

“…I read with interest the report of the multicentre randomised trial that compared transvaginal repair with or without midurethral sling insertion for patients with pelvic organ prolapse and stress incontinence of urine . Ideally, subsequent continence operations for patients having repair without sling insertion should have been included.…”