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SUI surgery at the time of vaginal POP repair: is a surgical algorithm possible or desirable?
1Case Western Reserve University, Cleveland, OH, USA. goldmah@ccf.org
Aims:
To review the question of whether SUI Surgery should be performed at the time of vaginal POP repair and whether a surgical algorithm is possible and report discussion on this topic from the ICI-RS meeting in 2010.
Methods:
The literature on this topic was surveyed and discussion from ICI-RS is reported.
Results:
There are multiple approaches to this question with literature supporting each of these approaches. Some perform an anti-incontinence procedure in all patients undergoing vaginal surgery, many are selective and only perform it in patients with symptoms or signs (including occult) of SUI and some perform it in no patients preferring to wait and see if they have symptoms of SUI post-operatively. There are a number of algorithms in use reflecting these practices but none agreed on by all. Ongoing trials may provide more information that allows the construction of better algorithms. All agreed that preoperative counseling was critical.
Conclusion:
Surgical practice regarding SUI surgery at the time of vaginal POP repair varies widely and there is conflicting literature that supports different approaches and algorithms. Ongoing trials should provide more information to help construct better algorithms. Other approaches for designing prediction models for this problem may be useful.
