abstract129 - LAPAROSCOPIC SACROCOLPOPEXY WITH OR WITHOUT MIDURETHRAL SLING INSERTION: ONE OR TWO STEP APPROACH? A PROSPECTIVE STUDY
LAPAROSCOPIC SACROCOLPOPEXY WITH ORWITHOUT MIDURETHRAL SLING INSERTION: ONE OR TWO STEP APPROACH? APROSPECTIVE STUDY
C. CHRISTMANN, E. BRUEHLMANN;
Frauenklinik Luzern, Lucerne, Switzerland.
Introduction: IntroductionThere is strong evidence that postoperative stress urinaryincontinence (SUI) is less frequent after the combination of prolapseand anti-incontinence surgery to prolapse surgery alone (Wei et al,Brubaker et al). However some data showed that a delayed approach isjustified (Borstad et al 2010).
The aim ofthis study was to compare the effectiveness and safety of combinedlaparoscopic sacrocolpopexy (SCP) for women with pelvic organprolapse and incontinence surgery with midurethral sling (MSU) inwomen with preoperatively diagnosed SUI or occult SUI versuslaparoscopic SCP alone with a delayed Approach.
Methods:MaterialsA prospective study (2013-2015) was performedincluding women with pelvic organ prolapse with concomitantsymptomatic SUI or occult SUI who underwent combination oflaparoscopic SCP with MUS insertion (group A) versus SCP alone (groupB) at our tertiary referral hospital of Cantonal Hospital of Lucerne,Switzerland. Primary outcome measures were asymptomatic regarding SUIafter prolapse surgery alone, persisting SUI or de novo SUI with orwithout subsequent anti-incontinence surgery. Preoperativelymultichannel urodynamic studies were performed in order to objectifythe symptoms. Urodynamic studies included a conventionalfilling-cystometry (with maximal bladder filling up to 500 ml),pressure-flow-study according to the recommendations of theInternational Continence Society (ICS). Residual urine was measuredand the clinical cough stress test and/or a pad-weight-test wereperformed in order to assess stress urinary incontinence with andwithout prolapse reduction. The Pelvic Organ Prolapse Quantificationsystem (POP Q) was performed according to the (ICS) in order toassess the degree of pelvic organ prolapse. To assess subjectiveoutcome women were asked to complete the validated Australian femalepelvic floor questionnaire. The follow-up periode was 6 weeks / 3months postoperatively.
A total of 137 patientswho underwent a laparoscopic SCP, 13 in combination with a MUSinsertion were included. Preoperatively 47% (n=65) with symptomaticSUI, 10% (n=13) with occult SUI and 43% (n=59) asymptomatic for SUI.39% (=48) of initial incontinent women no longer had SUI aftersacrocolpopexy alone, 15% (=19) showed persisting SUI and 6% (n=7)developed a de novo SUI. 7/ 19 women who showed persisting SUIpostoperatively requiring subsequent incontinence surgery. In thesubgroup of women that developed a de novo SUI three neededadditional anti-incontinence surgery (2 TVT, 1 bulking agent).Voiding dysfunction was seen in two patients in groupA.
Our study showed that POP surgery alonealmost 40% of women who were symptomatic no longer had SUI. Of thosewho had persisting or de novo SUI needed 10 of 26 women a subsequentanti-incontinence procedure. Overall only 6.5% of women with initialsymptomatic or occult SUI required an additional incontinencesurgery.Therefore we showed that a two-step approach is justified.Further RCT are urgently needed to proof the concept.