In a nutshell
This study examined combining pelvic prolapse repair surgery with vaginal sling procedures in an attempt to reduce urinary incontinence after surgery.
Researchers concluded that the risk of incontinence after surgery was significantly reduced by combining the two procedures.
Some background
Many women undergoing surgery for pelvic organ prolapse (POP) will experience incontinence after prolapse repair. Developing incontinence after prolapse repair is even more common among women with urinary incontinence before the surgery. POP surgery can be combined with vaginal sling procedures which treat stress incontinence. This study examined whether women with POP and early signs of stress urinary incontinence could benefit from combined surgery.
Methods & findings
231 women undergoing surgery to repair POP were included in this study. Of these, 91 women with POP and early signs of urinary incontinence were randomly assigned to undergo POP surgery combined with a vaginal sling procedure, or POP surgery alone. Urinary symptoms after surgery were compared and followed-up for one year.
Signs of incontinence before POP surgery nearly doubled the risk of developing stress urinary incontinence symptoms after surgery. This risk was reduced by inserting a vaginal sling during POP surgery. 86% of women with early incontinence signs who underwent combined surgery reported no incontinence symptoms within the first year. By comparison, only 48% of women undergoing POP surgery alone were symptom-free at one-year after surgery. None of the women that received the additional vaginal sling procedure needed any further treatment for urinary incontinence (compared to 21% of women undergoing POP surgery alone).
While more complications were observed when the two procedures were combined, there was no difference in severe complications (such as bladder injury or the need for further surgery). The most common minor complications noted with combined surgery included urinary tract infections and episodes of urinary retention.
The bottom line
Researchers concluded that adding a vaginal sling during POP surgery is safe and effective. Women should be informed about the possible benefits of combined surgery.
Published By :
International urogynecology journal
Date :
Jan 06, 2016
It is irresponsible to be promoting synthetic polypropylene mesh as an implant either for prolapse OR incontinence at this point. Where do you mention that the FDA has severe black-box warnings about the risk of extremely serious complications with POP mesh sling surgeries? As an admin for a 1,500 member mesh-injured support group and a woman who was disabled at age 40 from a midurethral mesh SUI sling, I strongly object to the fact that this article does not even mention the very severe complications from mesh slings that even the FDA admits are NOT RARE. Polypropylene mesh, whether implanted for POP or SUI, has a greater than 10% erosion rate. Erosion, if you haven’t experienced it, is when a sharp piece of plastic wears/cuts/slices through your vagina and urethra from the inside. It is like having the biggest, sharpest, most painful plastic splinter – but in your most sensitive region. I counsel hundreds of women daily who were simply not warned that there was a greater than 1 in 10 chance that they would require mesh explant surgeries (probably multiple). That they may never sit, have sex, walk, or live a day without pain for the rest of their lives. Please stop this one sided coverage of polypropylene mesh – it is dangerous.