Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 229; pp. 98 - 102
• Main Authors: Christmann-Schmid, Corina, Bruehlmann, Esther, Koerting, Isabell, Krebs, Joerg
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2018
• Subjects: Adult; Aged; Aged, 80 and over; Combined prolapse and anti-incontinence procedure; Female; Gynecologic Surgical Procedures; Humans; Laparoscopic; Laparoscopy; Middle Aged; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Prospective Studies; Sacrocolpopexy; Stress urinary incontinence; Suburethral Slings; Urinary Incontinence, Stress - surgery; Sacrocolpopexy; Pelvic organ prolapse; Stress urinary incontinence; Combined prolapse and anti-incontinence procedure; Laparoscopic
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2018.08.009

Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach. A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery. A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release. We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman.