Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings.

Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement.

The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling.

Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05).

The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups.

Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.

Female pelvic medicine & reconstructive surgery. 2022 Mar 01 [Epub]

Lauren Giugale, Amaanti Sridhar, Kimberly L Ferrante, Yuko M Komesu, Isuzu Meyer, Ariana L Smith, Deborah Myers, Anthony G Visco, Marie Fidela R Paraiso, Donna Mazloomdoost, Marie Gantz, Halina M Zyczynski, NICHD Pelvic Floor Disorders Network

From the Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA., RTI International, Research Triangle Park, NC., Kaiser Permanente, San Diego, CA., University of New Mexico, Albuquerque, NM., University of Alabama at Birmingham, Birmingham, AL., Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA., Brown University/Women & Infants Hospital, Providence, RI., Duke University, Durham, NC., Cleveland Clinic, Cleveland, OH., Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

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