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Prolapse surgery with or without incontinence procedure: a systematic review and meta-analysis
J M van der Ploeg1, A van der Steen2, S Zwolsman3
1Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands.
BJOG : an International Journal of Obstetrics and Gynaecology
|September 24, 2017
Summary
Combining prolapse repair with a midurethral sling (MUS) reduces the risk of postoperative stress urinary incontinence (POSUI) in women with pre-existing symptoms. However, this combination surgery also increases the risk of serious adverse events.
Area of Science:
- Urogynecology
- Pelvic Floor Surgery
- Female Urology
Background:
- Postoperative stress urinary incontinence (POSUI) is a risk following prolapse repair.
- Combining prolapse surgery with incontinence surgery may mitigate this risk.
Purpose of the Study:
- To compare the efficacy and safety of prolapse surgery performed with and without concurrent incontinence surgery.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, EMBASE, Cochrane Library, etc.) from 1995 to 2017.
- Included randomized trials compared prolapse surgery combined with a midurethral sling (MUS) or Burch colposuspension against prolapse surgery alone.
- Outcomes assessed included stress urinary incontinence, urgency incontinence, and adverse events.
Main Results:
- Vaginal prolapse repair with MUS significantly reduced the risk of subsequent POSUI in women with preoperative SUI symptoms or occult SUI.
- Serious adverse events were more frequent after vaginal prolapse repair with MUS compared to prolapse surgery alone.
- Combination surgery did not elevate the risk of overactive bladder symptoms, urgency incontinence, or voiding dysfunction.
Conclusions:
- Vaginal prolapse repair combined with a midurethral sling is effective in reducing POSUI for women with preoperative SUI symptoms or occult SUI.
- The increased risk of serious adverse events associated with this combined approach warrants careful consideration.
