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Should we combine vaginal prolapse surgery with continence surgery?
J Marinus van der Ploeg1, Jan-Paul W R Roovers2
1Department of Obstetrics and Gynecology, Martini Hospital, PO Box 30.033, 9700 RM, Groningen, The Netherlands. ploegjm@mzh.nl.
International Urogynecology Journal
|November 9, 2018
Summary
Combining prolapse repair with continence surgery reduces stress urinary incontinence (SUI) risk. However, predicting individual SUI and serious adverse event (SAE) risks is complex, making combination surgery decisions challenging.
Area of Science:
- Urogynecology
- Pelvic Floor Surgery
- Female Urology
Background:
- Combination surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) offers benefits but carries risks.
- Serious adverse events (SAEs) can occur after vaginal prolapse surgery with midurethral slings (MUS).
- Predicting individual patient risk for postoperative SUI and SAEs remains challenging.
Purpose of the Study:
- To propose a conceptual framework to aid in the decision-making process for combination surgery.
- To identify patient profiles that may benefit from combined prolapse repair and continence surgery.
Main Methods:
- Conceptual analysis of risk-benefit assessment for combination surgery.
- Evaluation of the average 9% risk of subsequent SUI surgery as a potential decision-making factor.
Main Results:
- A concept is presented to assist in considering combination surgery for POP and SUI.
- Women with an average 9% risk of needing subsequent SUI surgery may benefit from combined procedures.
Conclusions:
- Weighing the benefits of reduced SUI against the risks of SAEs in combination surgery is complex.
- The proposed concept, focusing on the 9% SUI re-operation risk, may help personalize treatment decisions.
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