The study reports a single center experience with endoscopic surgical management of female pelvic organ prolapse (POP) with and without urinary incontinence (UI). It aims to describe the effect of the laparoscopic POP surgery on the urinary tract anatomy and function, as it has been widely debated that to reduce the risk of postoperative stress UI (SUI) prolapse repair should be combined with UI surgery (1,2,3).

Prospective and observational study involving patients with symptomatic POP undergoing laparoscopic prolapse repair in a tertiary European hospital. Between November 2002 and December 2017, women with symptomatic POP undergoing to endoscopic surgical repair were included consecutively. Collected parameters: age, weight, height, medical and surgical background, urinary and genital exploration and data related to the surgery. This study was registered and received institutional review board approval by our Institutional Review Board and all patients gave their consent.

Sixty-six patients were included where mean age was 57.3 years old and mean BMI 27.3. 77.2% (n=51) of them underwent a sacrocolpopexy (SCP), 19.7% (n=13) a cervicosacropexy, 1.5% (n=1) a pectinopexy and 1.5% (n=1) a hysteropexy. 81.8% (n= 54) were laparoscopic, 16.6% (n=11) robotic and 1.5% (n=1) laparotomic. The rate of success a month after the surgery was 100% (n=66 out of 66) and a year after dropped to 89.8% (n=53 out of 59), although we should consider that 7 women have not already reached the year of surgery.

Bladder dysfunction is shown in the Table. Only 6% (n = 4) asked for an anti-incontinence surgery after the POP repair. None of the variables studied has shown an association to increase the risk of “de Novo” SUI after the POP surgery except for the urethral hypermobility, which has shown an increased risk of it.

Based on our results, urge and mixed UI heals spontaneously a year after the POP repair in 89% and 75% respectively. Meanwhile only 44% of women recover unwitting from SUI and 22% complain about “de Novo” SUI twelve months after it. 
Laparoscopic prolapse repair might improve unintentionally UI. We could consider not necessary to perform a systematic anti-incontinence procedure simultaneously to POP repair, unless the patient would accept the risks a combined surgery.

Funding: none

Van der Ploeg JM, van der Steen A, S Zwolsman , van der Vaart CH, Roovers JP. Prolapse surgery with or without  incontinence procedure: a systematic review and meta-analysis. BJOG. 2018 Feb;125(3):289-97.
Chapple, Christopher R. et al. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. European Urology , 2017 Sep;72 (3) 424-31
Trabuco EC, Linder BJ, Klingele CJ, Blandon RE, Occhino JA, Weaver AL, McGree ME, Gebhart JB. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol. 2018 Jan;131(1):31-8.