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Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A
Corina Christmann-Schmid1, Esther Bruehlmann1, Isabell Koerting1
1Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland.
Objective:
Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach.
Study Design:
A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery.
Results:
A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release.
Conclusion:
We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman.
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