Based on the previous studies that correlates between the laxity of the uterosacral ligaments (USL), the pelvic organ prolapse (POP) and the urgency urinary incontinence (UUI) in females, we offered a new thought for the surgical treatment of refractory UUI in females with POP which is restoring the function of the USLs and correcting the POP via sacrocolpopexy procedure and study its efficacy compared to the classical vaginal POP repair.

A prospective randomized interventional study from April 2017 to June 2019 including 34 patients with grade 2 or more POP (according to the POP-Q system; essentially anterior vaginal wall prolapse) complaining of refractory UUI (or mixed incontinence predominantly urgency). Patients were randomized into 2 groups. Group 1 (18 patients) underwent sacrocolpopexy. Group 2 (16 patients) underwent vaginal repair (anterior colporrhaphy). Evaluation included pre and post-operative detailed history (including ICIQ-SF questionnaire), physical examination, urinalysis, ultrasound, urodynamic evaluation and MRI.

A significant improvement in the patients' urinary incontinence and QOL ocurred in both groups. Regarding UUI, the overall improvement (cured or improved) in group 1 after SCP was 77.68 %, and in group 2 after classical repair was 50 %. Regarding the anterior compartment prolapse; similar success rates were found;  94.4 % (17/ 18) and only 1 case of recurrence (5.6%) in group 1; versus 87.5% (14 of 16) and 2 cases of recurrence (12.5 %) in group 2 (p value > 0.05).

Pre-operatively, the ICIQ score of group 1 and 2 had a mean (±SD) of 17.7 (±2.1)  and 18.2 (±1.4) respectively. Post-operatively, the score of group 1 and 2 had a mean (±SD) of 9.4 (±5.7) and 9.6(±5.1) respectively  showing a statistically significant difference between the pre and post-operative ICIQ scores denoting a significant improvement in the patients' urinary incontinence and QOL of both groups. Regarding UUI, the overall improvement (cured or improved) in group 1 after SCP was 77.68 %, and in group 2 after classical repair was 50 %. No difference was found between the improvement of patients who had pre-operative urodynamic detrusor overactivity and those who did not. Regarding SUI ,  in group 1 (16/18 patients); sacrocolpopexy cured 69% (11 out of 16) while in 31% (5 out of 16) SUI persisted and de novo SUI occurred in 1 of the 2 stress continent cases. In group 2 (SUI in 12/16 patients), TOT insertion cured 83% (10/12) while in 17 % (2/12) SUI persisted and de novo SUI occurred in 1 of the 4 stress continent cases after repair.
SCP patients were spared an additional procedure and its complications (TOT) that have been done to 12 MUI patients in the vaginal repair arm to eventually achieve a similar SUI cure rate (83.3% versus 69 % for SCP arm). Regarding the anterior compartment; similar success rates were found;  94.4 % (17/ 18) and only 1 case of recurrence (5.6%) in group 1; versus 87.5% (14 of 16) and 2 cases of recurrence (12.5 %) in group 2 (p value > 0.05).

Sacrocolpopexy is an effective and durable surgical option for females with UUI or MUI and POP and superior to vaginal repair. No correlation was found between the improvement and pre-operative urodynamic detrusor overactivity.