Indications for Anti-Incontinence Procedures in Women with Severe Anterior Prolapse

ABSTRACT

Introduction and Objectives: The aims of the present study were to determine the indications for anti-incontinence surgery and evaluate the efficacy of different methods (combination of anterior colporraphy with TVT, vaginal wall sling (VWS), Raz needle suspension) in preventing postoperative stress urinary incontinence (SUI) in women undergoing surgery for severe urogenital prolapse.

Materials and Methods: The prospective study included 62 clinically continent patients who were underwent surgery in 1999 – 2003 for cystocele grade III/IV. All patients were clinically evaluated, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test and urodynamics. The urodynamic evaluation was repeated with prolapse repositioning by a fitted vaginal pessary.

Results: 16 women with no urodynamic evidence of intrinsic sphincteric deficiency (ISD) underwent anterior colporrhaphy, no additional anti-incontinence procedure was performed. Mean follow up in this group was 53 months (range 34 to 71). In 2 patients de-novo stress urinary incontinence was detected. In remaining 46 women with ISD after prolapse reduction, anterior colporrhaphy was combined with TVT (21 patients), vaginal wall sling ( 15 patients), and Raz needle suspension (10 patients). Mean follow up in these group was 51 months (range 36 to 70). None had postoperative stress urinary incontinence in TVT group. Stress urinary incontinence was manifested in 6 out of 15 patients after VWS and in all patients after Raz needle suspension (during follow up).

Conclusions: According to our results, in women with severe urogenital prolapse, preoperative urodynamic evaluation with and without prolapse reduction is essential for correct detection of occult stress urinary incontinence. The decision making of a concomitant prophylactic anti-incontinence procedure should be individualized in accordance to urodynamic findings. In patients with urodynamic ISD, an additional, effective anti-incontinence procedure should be performed during surgical correction of genitourinary prolapse. In such patients, TVT in comparison with VWS and Raz needle suspension seems to be more promising.

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