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Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial.
BJOG. 2015 Jun; 122(7):1022-30.BJOG

Abstract

OBJECTIVE

To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only.

DESIGN

Multi-centre randomised trial.

SETTING

Fourteen teaching hospitals in the Netherlands.

POPULATION

Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction.

METHODS

Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat.

MAIN OUTCOME MEASURES

The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications.

RESULTS

One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54).

CONCLUSIONS

Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

van der Ploeg JM
Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands.
Oude Rengerink K
Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
van der Steen A
Department of Obstetrics and Gynaecology, Zorggroep Twente, Hengelo, the Netherlands.
van Leeuwen JH
Department of Obstetrics and Gynaecology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Stekelenburg J
Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands.
Bongers MY
Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
Weemhoff M
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Mol BW
School of Pediatrics and Reproductive Health, The Robinson Institute, University of Adelaide, Adelaide, SA, Australia.
van der Vaart CH
Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands.
Roovers JP
Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Dutch Urogynaecology Consortium
No affiliation info available

MeSH

AgedFemaleGynecologic Surgical ProceduresHumansMiddle AgedNetherlandsPelvic Organ ProlapseSuburethral SlingsSurveys and QuestionnairesTreatment OutcomeUrinary Bladder, OveractiveUrinary Incontinence, Stress

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25754458

Citation

van der Ploeg, J M., et al. "Transvaginal Prolapse Repair With or Without the Addition of a Midurethral Sling in Women With Genital Prolapse and Stress Urinary Incontinence: a Randomised Trial." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 122, no. 7, 2015, pp. 1022-30.
van der Ploeg JM, Oude Rengerink K, van der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG. 2015;122(7):1022-30.
van der Ploeg, J. M., Oude Rengerink, K., van der Steen, A., van Leeuwen, J. H., Stekelenburg, J., Bongers, M. Y., Weemhoff, M., Mol, B. W., van der Vaart, C. H., & Roovers, J. P. (2015). Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG : an International Journal of Obstetrics and Gynaecology, 122(7), 1022-30. https://doi.org/10.1111/1471-0528.13325
van der Ploeg JM, et al. Transvaginal Prolapse Repair With or Without the Addition of a Midurethral Sling in Women With Genital Prolapse and Stress Urinary Incontinence: a Randomised Trial. BJOG. 2015;122(7):1022-30. PubMed PMID: 25754458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. AU - van der Ploeg,J M, AU - Oude Rengerink,K, AU - van der Steen,A, AU - van Leeuwen,J H S, AU - Stekelenburg,J, AU - Bongers,M Y, AU - Weemhoff,M, AU - Mol,B W, AU - van der Vaart,C H, AU - Roovers,J-P W R, AU - ,, Y1 - 2015/03/09/ PY - 2015/01/02/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/8/12/medline KW - Midurethral sling KW - pelvic organ prolapse KW - randomised KW - stress urinary incontinence SP - 1022 EP - 30 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 122 IS - 7 N2 - OBJECTIVE: To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. DESIGN: Multi-centre randomised trial. SETTING: Fourteen teaching hospitals in the Netherlands. POPULATION: Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. METHODS: Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. MAIN OUTCOME MEASURES: The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. RESULTS: One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54). CONCLUSIONS: Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/25754458/Transvaginal_prolapse_repair_with_or_without_the_addition_of_a_midurethral_sling_in_women_with_genital_prolapse_and_stress_urinary_incontinence:_a_randomised_trial_ DB - PRIME DP - Unbound Medicine ER -