The goal of surgical treatment of pelvic organ prolapse (POP) is to repair the anatomical defects. However, it has been described that surgical repair also affects the lower urinary tract symptoms (LUTS) associated with POP such as urgency, stress urinary incontinence (SUI) and voiding symptoms.
	Some authors suggest that surgical POP correction lead to de novo SUI because it unmasks an occult SUI, and that in laparoscopic sacrocolpopexy (LSC), an excessive perivesical dissection may injury bladder innervation facilitating the apparition of LUTS.
	Our hypothesis is that robot-assisted LSC (RLSC) besides to repair POP, also decreases postoperative the LUTS associated with POP, and that if there is an occult SUI it will be useful to add an incontinence surgical technique like Trans Obturator Tape (TOT) to prevent postoperative SUI. Consequently, our aim is to analyse outcomes of RLSC for POP correction, and to establish possible risk factors on developing postoperative urgency, symptomatic SUI and voiding symptoms

Study design. Longitudinal prospective
Material and methods
	A longitudinal study was carried out with 51 consecutive women of mean age (± standard deviation) 66 ± 9,0 years who underwent robotic SCL. Inclusion criteria were: aged ≥ 18 years, and POP stage ≥ 2 according to the validated Pelvic Organ Prolapse Quantification system (POP-Q). Patients were excluded if they had neurogenic lower urinary tract dysfunction, active urinary tract infection, lithiasis or genitourinary neoplasia.
	Sample size was calculated based on the data provided by Leruth et al (1). Assuming a symptomatic preoperative SUI of 54% and a postoperative SUI of 24%, a statistical power of 80% and an alpha level of 5%, the minimum sample size was calculated at 46 patients. 
	Preoperative evaluation involved a clinical history. Patients were asked about the existence of urgency, symptomatic SUI and voiding symptoms according to International Continence Society (ICS) definitions, a gynaecologic exploration assessing the stage and type of POP according to POP-Q and a urodynamic study in 46 cases. The urodynamic study was performed in accordance with the specifications of the ICS and guidelines for Good Urodynamic protocols.  The screen for occult SUI consisted in a stress testing with instrumental prolapse reduction. In 38 patient the test was positive and concomitant TOT was performed.


Postoperative evaluation was routinely performed at six months follow-up and included history asking again for the existence of the three LUTS, and a gynaecologic exploration.  Failure to correct POP was defined as a persistence or recurrence of POP stage ≥ 2.  
	McNemar test and the Fisher exact test were used to analyze dependent variables. Student t test was performed for independent variables. Statistical significance was set in p<0.05 (bilateral).

Results regarding postoperative outcome is shown in table 1
 
A significant postoperative improvement was observed in the correction of apical and anterior compartments, but not in posterior compartment. Voiding symptoms and symptomatic SUI also improved after RLSC, but not urgency. 
The only preoperative risk factor demonstrated in our study for postoperative symptomatic SUI was the concomitant TOT application. Patients with concomitant TOT application had 8% postoperative symptomatic SUI versus 42% of patients without TOT (p =0.017). The only preoperative risk factor for postoperative urgency was the existence of preoperative urgency. Postoperative urgency was present in 59% patients with preoperative urgency versus 15% of patients without preoperative urgency (p = 0.003). There were no demonstrated preoperative risk factors for postoperative voiding symptoms.

LSC was not effective to improve posterior POP. This was also reported by Claerhout et al (2). The improvement of voiding symptoms may be the result of removing bladder outlet obstruction associated with anterior and apical prolapse. Urgency might arise from preoperative sensory alteration (3) which are not resolved with RSCP. POP repair is associated to the novo SUI in some patients, because POP may mask this SUI.

Robot-assisted sacrocolpopexy was useful for anterior and apical POP corrections and improves significantly associated voiding symptoms. Performing a transobturator suburethral sling on patients with a positive occult stress urinary incontinence test is useful in order to prevent postoperative symptomatic SUI

Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J. 2013 ;24(3):485-91
Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, Coremans G, Deprest J. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55(6):1459-67
Banakhar MA, Al-Shaiji TF, Hassouna MM. Pathophysiology of overactive bladder. Int Urogynecol J. 2012;23(8):975-82.