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Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study.
Eur J Obstet Gynecol Reprod Biol. 2018 Oct; 229:98-102.EJ

Abstract

OBJECTIVE

Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach.

STUDY DESIGN

A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery.

RESULTS

A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release.

CONCLUSION

We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Christmann-Schmid C
Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland. Electronic address: corina.christmann@luks.ch.
Bruehlmann E
Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland.
Koerting I
Department of Urogynaecology, Cantonal Hospital of Lucerne, Switzerland.
Krebs J
Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.

MeSH

AdultAgedAged, 80 and overFemaleGynecologic Surgical ProceduresHumansLaparoscopyMiddle AgedPelvic Organ ProlapseProspective StudiesSuburethral SlingsUrinary Incontinence, Stress

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30144729

Citation

Christmann-Schmid, Corina, et al. "Laparoscopic Sacrocolpopexy With or Without Midurethral Sling Insertion: Is a Two- Step Approach Justified? a Prospective Study." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 229, 2018, pp. 98-102.
Christmann-Schmid C, Bruehlmann E, Koerting I, et al. Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study. Eur J Obstet Gynecol Reprod Biol. 2018;229:98-102.
Christmann-Schmid, C., Bruehlmann, E., Koerting, I., & Krebs, J. (2018). Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 229, 98-102. https://doi.org/10.1016/j.ejogrb.2018.08.009
Christmann-Schmid C, et al. Laparoscopic Sacrocolpopexy With or Without Midurethral Sling Insertion: Is a Two- Step Approach Justified? a Prospective Study. Eur J Obstet Gynecol Reprod Biol. 2018;229:98-102. PubMed PMID: 30144729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic sacrocolpopexy with or without midurethral sling insertion: Is a two- step approach justified? A prospective study. AU - Christmann-Schmid,Corina, AU - Bruehlmann,Esther, AU - Koerting,Isabell, AU - Krebs,Joerg, Y1 - 2018/08/08/ PY - 2018/02/22/received PY - 2018/06/08/revised PY - 2018/08/07/accepted PY - 2018/8/26/pubmed PY - 2019/1/30/medline PY - 2018/8/26/entrez KW - Combined prolapse and anti-incontinence procedure KW - Laparoscopic KW - Pelvic organ prolapse KW - Sacrocolpopexy KW - Stress urinary incontinence SP - 98 EP - 102 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 229 N2 - OBJECTIVE: Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach. STUDY DESIGN: A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery. RESULTS: A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release. CONCLUSION: We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/30144729/Laparoscopic_sacrocolpopexy_with_or_without_midurethral_sling_insertion:_Is_a_two__step_approach_justified_A_prospective_study_ DB - PRIME DP - Unbound Medicine ER -