SUFU 2019: Prophylactic Midurethral Slings at the Time of Pelvic Organ Prolapse Repair Surgery to Prevent De-Novo Stress Urinary Incontinence - A Need to Reappraise?

Miami, FL ( Prophylactic sling placement may prevent de-novo stress urinary incontinence (SUI) in women undergoing pelvic organ prolapse (POP) surgery. However, there is a growing concern that this strategy may lead to overtreatment of a potential issue with continence as well as complications related to sling placement.

Kai B. Dallas, MD, and his group at Stanford University presented their analysis of women undergoing vaginal based POP surgery with and without a concomitant SUI procedure and their rates of repeat surgeries.

Using the Office of Statewide Health Planning and Development databases, the Stanford group identified all women undergoing POP repair in California from 2005-2011. They then compared the rates of repeat surgeries in those with and without concomitant SUI repairs were compared. Two models were created to better estimate the multivariate risk of a sling complication (Model 1) and the multivariate risk of future SUI surgery (Model 2). Both models were applied to all patients, and the estimated risk for each patient for each strategy was created. Logistic regression models were therefore constructed to theoretically compare each patient's individualized risk of requiring a future SUI procedure if one was not performed at the time of POP repair, compared to a surgical complication if a prophylactic SUI procedure was performed prophylactically.

Of the 81,314 women studied, 38,456 underwent a concomitant SUI procedure, and 42,858 did not. Those who had SUI surgery at the time of POP repair were more likely to undergo surgery for a complication compared to those who underwent a delayed SUI surgery (3.5% versus 3.0%, p<0.001). Multivariate modeling revealed that most women undergoing POP repair would have a higher risk of requiring SUI revision surgery if a SUI operation was performed concomitantly (60%), and that their risk of needing a future SUI surgery was 40% if not performed concomitantly (Figure 1).
UroToday SUFU2019 Midurethral Slings2

Based on their findings, Dr. Dallas concluded that women who undergo POP repair without concurrent SUI repair have a lower risk of future surgery compared to those who have POP and SUI repairs performed concomitantly. Their results, therefore, contradict the belief that prophylactic sling surgery at the time of a POP repair might decrease the risk of future surgery.

Presented by: Kai B. Dallas, MD, Stanford University, Department of Urology, Stanford, California

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida