Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

• Published in: BJOG : an international journal of obstetrics and gynaecology 2015-06, Vol.122 (7), p.1022-1030
• Main Authors: Ploeg, JM, Oude Rengerink, K, Steen, A, Leeuwen, JHS, Stekelenburg, J, Bongers, MY, Weemhoff, M, Mol, BW, Vaart, CH, Roovers, J‐PWR
• Format: Article
• Language: English
• Subjects: Aged; Female; Gynecologic Surgical Procedures - methods; Humans; Middle Aged; Midurethral sling; Netherlands; pelvic organ prolapse; Pelvic Organ Prolapse - surgery; randomised; stress urinary incontinence; Suburethral Slings - utilization; Surgery; Surveys and Questionnaires; Treatment Outcome; Urinary Bladder, Overactive - prevention & control; Urinary incontinence; Urinary Incontinence, Stress - surgery; Women
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.13325

Objective To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Design Multi‐centre randomised trial. Setting Fourteen teaching hospitals in the Netherlands. Population Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. Methods Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. Main outcome measures The primary outcome at 12 months’ follow‐up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. Results One hundred and thirty‐four women were analysed at 12 months’ follow‐up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39–3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44–2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11–0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93–8.54). Conclusions Women with prolapse and co‐existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well‐informed decision balancing risks and benefits of both strategies should be tailored to individual women.