Does concurrent pelvic organ prolapse surgery affect outcomes of mid-urethral Sling? A tertiary care experience

To compare the efficacy of mid-urethral sling surgery with and without concurrent pelvic organ prolapse surgery.

The retrospective chart review was conducted in May 2022 at the Aga Khan University Hospital, Karachi, and comprised data of female patients who underwent mid-urethral sling surgery either through tension-free vaginal tape or trans obturator tape for stress urinary incontinence between January 2010 and December 2020 and had a complete 12-month follow-up data available. Two groups were formed: Group A had mid-urethral sling surgery cases, while Group B, had cases with concurrent mid-urethral sling and pelvic organ prolapse surgery. Documented parameters, including preoperative data, postoperative complications and satisfaction levels using urogenital distress inventory-6 and incontinence impact questionnaire-7 tools, were compared between the groups. Negative cough stress test was defined as objective cure. Data was analysed using SPSS 19.

Of the 345 females, 122(35.4%) were in Group A, with 68(55.7%) aged <50 years. There were 223(64.6%) females in Group B, with 127(57%) aged >50 years(p>0.05). Parity >3 and menopause were significantly higher in Group B (p<0.05), but a positive preoperative cough stress test was high in Group A (p=0.001). At 12-month followup, objective and subjective cure rates were not significantly different between the groups (p>0.05). However, at 6 months, urogenital distress inventory-6 scores were significant between the groups (p<0.05). Body mass index was associated with objective failure at 6months. Mid-urethral sling type and the presence of concurrent prolapse surgery had no significant effect (p>0.05).

Undergoing simultaneous prolapse surgery and mid-urethral sling surgery had similar risks and success rates as undergoing mid-urethral sling surgery alone.