In a nutshell
This study aimed to investigate the best surgical treatment for pelvic organ prolapse (POP) in women, with and without stress urinary incontinence (SUI). This study found that women who had SUI at the time of surgery benefited from an additional procedure (mid-urethral sling) at the time of POP repair.
Pelvic organ prolapse (POP) is a common condition, especially among women who have given birth and who are postmenopausal. It involves the descent of pelvic organs such as the womb (uterus), bladder, bowel, and vagina within and outside of the vagina. It is commonly associated with urinary leakage on coughing or physical exertion. This is known as stress urinary incontinence (SUI). However, in some women, the prolapsed organ prevents leakage from the bladder. In this case, SUI may only occur once the prolapsed organ has been replaced into the pelvis. SUI may also develop only after surgical treatment of prolapse.
The best surgical treatment for POP, with and without SUI, is not known.
Methods & findings
This study included 2717 women. All women in this study had surgery for POP. The surgery to treat POP could use vaginal tissue or a vaginal mesh implant to support pelvic organs.
Women who had SUI at the time of surgery benefited from an additional procedure at the time of POP repair. This is called a mid-urethral sling. It provides support for the urethra (where urine passes through from the bladder) and lowers the chance of SUI occurring again. The mid-urethral sling could also be postponed for three months after prolapse surgery with similar success rates. In this situation, some women might avoid another operation.
Fewer women had urinary leakage after vaginal tissue repair, as compared to vaginal mesh implant. However, vaginal mesh placement reduced the chance of prolapse happening again.
The bottom line
This study found that women who had SUI at the time of POP surgery had better results when another procedure (mid-urethral sling) was done at the time of POP repair.
The fine print
The patients included came from different hospitals and surgical procedures may have had different protocols.
Speak to your physician for more information on the different types of surgeries.
Published By :
Cochrane database of systematic reviews
Aug 19, 2018
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