Study On Concomitant Reductive Surgery Of Advanced Pelvic Organ Prolapse And Anti-incontinence Sling For Treatment Of Occult Stress Urinary Incontinence

Objective: To evaluate the clinical outcome of anti-incontinence sling (TVT/TVT-O)in the treatment of occult stress urinary incontinence (OSUI) during reductive surgeryfor advanced pelvic organ prolapse (POP).Methods: From Jun.2003to Dec.2012,78patients with occult stress urinaryincontinence underwent reductive surgery for advanced POP such as high uterosacralligament suspension, sacrospinous ligament suspension and sacral colpopexy in theFirst Affiliated Hospital, Chinese PLA General Hospital&Chinese PLA MedicalSchool. Among them,41patients received reductive surgery alone was enrolled innon-concomitant anti-incontinence group and the other37patients who underwent samesurgery with TVT or TVT-O was in anti-incontinence group. The patient’s demography,objective and subjective outcomes, as well as complications and injures were comparedbetween the two groups. The POP-Q was used to evaluate the objective outcomes ofPOP. Urinary distress inventory(UDI-6) and incontinence impact questionnaire shortform(IIQ-7) were used to evaluate the subjective outcomes of SUI.Result: Compared with the non-concomitant anti-incontinence procedure group，the objective outcomes of reductive surgery exhibited no significant differences andonly the operation time of anti-incontinence group slightly increased15.8min.Theoccurrence rate of postoperative SUI was12.2%（5/41）、14.6%（6/41）、17.1%（7/41）respectively after the operation at2-month,6-month and12-month follow up in thenon-concomitant anti-incontinence group.And the occurrence rate of theanti-incontinence group was2.7%（1/37）、2.7%（1/37）、2.7%（1/37）. But none ofpatients in the two groups require further surgery for stress urinary incontinence. Meanscore of UDI-6and IIQ-7in all the patients decreased significantly after operation at 6-month,12-month and24-month follow up. However, there was no statistic differencebetween the two groups.Conclusions:1.High uterosacral ligament suspension(HUS), sacrospinous ligamentsuspension(SSLS) and sacral colpopexy(SC) are effective procedures for vaultprolapse.2. As a safe and effective procedure in the treatment of SUI, the anti-incontinenceslings(TVT/TVT-O) can reduce the incidence of postoperative stress urinaryincontinence.3.The POP patients with severe OSUI are more likely to suffer SUIpostoperatively and one-step treatment approach is recommended.4.To the POP patients with no severe OSUI，a two-step approach to correct thepostoperative stress urinary incontinence is also reasonable.