Continence surgery at the time of POP repair TOG 2018

Question 1

What proportion of women are effected by prolapse?

Answer 1

1 in 9

Question 2

What proportion of women are effected by urinary incontinence?

Answer 2

1 in 3

Question 3

Prevalence of UI in women >40yrs?

Answer 3

25-45%, stress most common

Question 4

How common prolapse stage 2 or greater 12 years after 1st delivery

Answer 4

> 1/2

Question 5

How common SUI in POP

Answer 5

80%

Question 6

How likely PFMT to improve prolapse stage

Answer 6

17%

Question 7

Rates of SUI following abdominal sacrocolpopexy with or without Burch Colposuspension?

Answer 7

With Colposuspension: 6%
Without 25%

Question 8

What proportion of women who have vaginal prolapse repair will have stress urnairy incontinence after the procedure (Occult SUI)

Answer 8

1 in 4

Question 9

What procedure can be offered to prevent SUI following vaginal prolapse repair?

Answer 9

Synthetic midurethral sling

Question 10

Number needed treat with Synthetic midurethral sling to prevent 1 case of post-op SIO at 1 year

Answer 10

6.3

Question 11

% of bladder injury with Synthetic midurethral sling at time of vaginal surgery

Answer 11

7%, all managed intra-operatively

Question 12

Need for repeat surgery vaginal wall surgery for prolapse alone Vs with SMUS

Answer 12

Alone 5%
+SMUS 2.5%

Question 13

What is occult stress urniary incontience

Answer 13

SUI following reduction of POP in women who are aymptomaitc, prolapse can lead to urethral kinking and preservation unmasks UI

Question 14

Can you diagnose occult SI

Answer 14

No

Question 15

Rate symptomatic post-op SIO in combination surgery

Answer 15

30%
?Better to do interval surgery, POP alone and dealing SUI if/when required

Question 16

Does SMUS at time of vaignal prolapse repair for women with prolapse + SUI reduce rate of SUI post op?

Answer 16

Yes persistent SUI at 3 months 5% vs 23%

In prolapse surgery alone, 27% cured SIO, 57% persistent SUI interval SMUS, 16% persistant SUI, no further surgery

Question 17

For women with prolapse + SUI undergoing abdominal sacrocolpopexy does concomitant Colposuspension reduce rates of post op SUI

Answer 17

No, higher rate persitant SUI in Burch Colp group

Question 18

For women with prolapse + SUI undergoing abdominal sacrocolpopexy does concomitant SMUS procedures reduce rates of post op SUI

Answer 18

Yes higher rate SUI cure 98% vs 70%

Question 19

NNT for vaginal POP surgery + SMUS to prevent one subsequent SMUS

Answer 19

10
Near 1/3 experience cure of SUI symptoms

Question 20

Any evidence to treat asymptomatic prolapse at time of stress UI surgery

Answer 20

No benefit