The debate on the role of concomitant surgery for incontinence at the time of prolapse surgery is not new. Several studies attempted to evaluate different procedures in recent years. Brubaker et al. randomized women to sacral colpopexy (SCP) with or without a Burch colposuspension and demonstrated an advantage of prophylactic Burch colposuspension for stress incontinence at 3 months and 2 year follow up.1,2 Moon et al showed that women undergoing transobturator sling procedures for symptomatic stress incontinence at the time of SCP had significantly lower hospital stay, urinary retention, de novo urgency and recurrent SUI when compared to those having a Burch colposuspension.3 The authors of a recent study “Outcomes of three sling procedures at the time of abdominal sacral colpopexy” (Ryan W. Tubre, Priya Padmanabhan, Clifton F. Frilot, Wesley Porta and Alex Gomelsky. Neurourology and Urodynamics, online: 29 January 2016) compared the outcomes of three sling procedures in women undergoing abdominal sacral colpopexy: autologous rectus fascia bladder neck sling (ARF), retropubic midurethral sling (RPM) and transobturator midurethral sling (TOM). This was a retrospective single institution, single-surgeon review with minimum follow-up of 12 months and included 152 women.
The authors found that stress incontinence cure rates were not significantly different between sling groups, or within each group after stratification by overt and occult SUI. There was a trend towards TOM being the least effective among the three slings. Quality of life improved after surgery for the entire cohort. It was therefore concluded that all three sling types appear to result in similar cure rates of SUI.
Although there is an advantage to performing both the prolapse repair and an anti-incontinence procedure concomitantly, a recent meta-analysis concluded that in vaginal repairs with concomitant MUS, there are higher complication rates, including prolonged catheterization.4 This meta-analysis also showed that when a prolapse repair was performed using a vaginal approach, the tension-free tape (TVT) or obturator (TVT-O) was the preferred procedure, but when an abdominal SCP was performed, the Burch colposuspension was the anti-incontinence procedure of choice. The current study is limited as a single institution retrospective review. It is also limited by the different selection of continence procedures by the surgeon over the study period and different follow up period between the different groups. These limitations highlight the need for ongoing and high quality prospective research.
Article by the Publications and Communications Committee
Ryan W. Tubre, Priya Padmanabhan, Clifton F. Frilot, Wesley Porta and Alex Gomelsky. Neurourology and Urodynamics, online: 29 JAN 2016
Burch colposuspension versus fascial sling to reduce urinary stress incontinence, Albo ME et al.
Brubaker et al. N Engl J Med 2007; 357:1457, Brubaker et al Obstet Gynecol 2008; 112:49–55.
Moon et al. Int J Gynecol Obstet 2011; 112:122–5.
van der Ploeg et al. BJOG 2014; 121:537–47.