SUFU 2018: Is Prophylactic Stress Incontinence Surgery Necessary at the Time of Pelvic Organ Prolapse Repair?

Austin, TX ( Dr. Syan and colleagues presented a retrospective study of 1,504 women who had undergone index pelvic organ prolapse (POP) repair without concomitant SUI surgery, then necessitating subsequent SUI repair.  The cohort was obtained from the Office of Statewide Health Planning and Development in California, from 2005 to 2011, with at least 1 year of follow up.  Mean follow up was 4.1 years.  Using multivariate analysis, patient and surgical characteristics were examined for associations with future SUI procedures after index POP repair.

The authors found that on multivariate analysis, obesity (odds 1.99, p<0.001), use of mesh at the time of POP repair (odds 2.04, p<0.001), diabetes mellitus (odds 1.19, p=0.04) and being Caucasian were associated with an increased odds of future SUI surgery.  They found no difference in the odds of future SUI surgery between anterior alone and apical alone repairs (p=0.44), however, combination repairs carried a higher risk (odds 1.30, p<0.001).

The authors conclude that of the factors identified for increased risk for future SUI surgery, the strongest positive predictor was the use of mesh.  The authors feel a strength of the study is the large and diverse population, which may be more generalizable to US population, but admit they are limited by a lack of data of physical exam findings.  A follow up question was raised that from this study, we may not be able to conclude on the practice of prophylactic SUI surgery at the time of POP surgery.

Presented By: Raveen Syan, MD¹

Co-Authors: Kai Dallas MD², Ericka Sohlberg MD¹, Lisa Rogo-Gupta MD¹, Christopher Elliott MD¹ and Ekene Enemchukwu MD¹

Author Information: 1. Stanford, CA; 2. Stanford Urology

Written by: Cristina Palmer, DO. Female Urology, Pelvic Reconstruction, Voiding Dysfunction Fellow, Department of Urology, UC Irvine Medical Center, Orange, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas