Continence surgery at the time of pelvic organ prolapse repair: a review of the literature Flashcards
Pelvic floor muscle training,
increases the chance of improving prolapse stage by more than 30% compared with no treatment. T/F
False
2011 Cochrane review concluded that PFMT increased the chance of improvement in prolapse stage by 17% compared to no treatment
Pelvic floor muscle training
is associated with less improvement in symptoms compared with synthetic midurethral sling (SMUS) in women with stress urinary incontinence (SUI). T ⬜ F ⬜
True
large, multicentre RCT compared physiotherapy and synthetic midurethral sling (SMUS) surgery in women with SUI and showed significantly higher patient-reported success rates in women who underwent SMUS compared with PFMT at 1 year of follow-up (91% versus 65%; 95% confidence interval [CI] 18.1–34.5).
Pelvic organ prolapse,
at or beyond stage 2 has been observed in up to one in four women 12 years after their first delivery. T ⬜ F ⬜
True
In a large observational cohort study, anatomical prolapse graded as stage 2 or greater was observed in more than one in two women, 12 years after their first delivery.
POP affects an estimated one in five women. T ⬜ F ⬜
False
POP affects 1 in 9 women
POP and SUI coexist in up to 80% of women. T ⬜ F ⬜
True
POP and SUI may coexist in up to 80% of women
Surgical treatment,
for SUI is required for approximately 10% of parous women over a lifetime. T ⬜ F ⬜
True
In the UK, the lifetime risk for parous women to undergo at least one surgical treatment for either SUI or POP has been shown to be 1:10 Other studies have shown a greater lifetime risk of 19–20%
Surgical treatment for SUI is required for less than 50% of women with symptomatic incontinence before and after vaginal prolapse repair. T ⬜ F ⬜
False
The authors calculated that approximately one in four women who were previously asymptomatic for SUI would develop SUI after having only had their prolapse repaired.
Abdominal sacrocolpopexy
was shown to result in significantly greater SUI in the CARE trial when combined with concomitant Burch colposuspension. T ⬜ F ⬜
False
Enrolment to this trial was stopped after the first interim analysis because of a significantly lower frequency of postoperative SUI in the group that underwent concomitant BC (6.1% versus 24.5%, P < 0.001).
Abdominal sacrocolpopexy when combined with Burch colposuspension, has been shown to have no significant increase in serious adverse events compared with sacrocolpopexy alone. T ⬜ F ⬜
True
The number of serious adverse events was similar in both groups up to 3 months of follow-up, but operative time and blood loss were both higher in the combined surgery group
Regarding SMUS at the time of vaginal prolapse repair -
in continent women with stage 3 or 4 prolapse, retropubic tension-free vaginal tape has been shown to reduce the rate of postoperative SUI. T ⬜ F ⬜
True
in the subset of women with stage 3 or 4 POP without preoperative SUI, RP-TVT reduced the incidence of postoperative SUI by approximately 90%. BC, on the other hand, was not associated with a significant reduction in postoperative SUI symptoms.
Regarding SMUS at the time of vaginal prolapse repair -
a rate of bladder injury of up to 8.7% has been reported. T ⬜ F ⬜
False
Adding a continence procedure at the time of prolapse repair can, however, increase the risk of surgical complications. In the OPUS trial, known complications of SMUS, including bleeding, urinary tract infection and bladder injury were higher at 6 weeks postoperatively in the group randomised to combined surgery; 6.7% of women sustained bladder injury.22 Reassuringly, all bladder injuries were managed intraoperatively with no long-term consequences.
Occult SUI,
has no standardised diagnostic test. T ⬜ F ⬜
True
There is currently no standardised diagnostic method for detecting OSI,28 and the role of preoperative urodynamics in the identification of OSI is uncertain.
Occult SUI,
has a ten-fold higher detection rate with speculum testing compared with ring pessary use. T ⬜ F ⬜
False
In the CARE trial, various prolapse reduction methods to detect OSI were assessed and speculum testing was shown to be the most sensitive, with a five-fold higher detection rate compared to the ring pessary.29
Occult SUI,
was detected in approximately one-third of women in the CARE and OPUS trials. T ⬜ F ⬜
True
In the OPUS and CARE trials, 33% and 27% of women who were asymptomatic for SUI had OSI on prolapse reduction,
Asymptomatic prolapse,
of stage 2 has been reported in more than one-third of women presenting with SUI symptoms. T ⬜ F ⬜
True
SUI and asymptomatic POP. Norton et al.35 analysed the progression of POP over 5– 7 years of follow-up in 597 women randomised to receive RP-TVT or TO-TVT with and without POP repair. Stage 2 prolapse was identified in 49% of women at baseline; anatomic progression of POP occurred in only 3/ 189 women (2%) over 72 months of follow-up, and none had POP surgery.
