Orris

What id the treatment of both UV prolapse and stress incontinence occur

Reading File
Finding Sources
Finding Sources
Searching PubMed

pelvic organ prolapse AND stress urinary incontinence AND surgical treatment

Finding Sources
Finding Sources
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Finding Sources
Reading File
I now have enough information from the authoritative textbooks to give a thorough answer. Here it is:

Treatment When Uterovaginal (UV) Prolapse and Stress Urinary Incontinence (SUI) Coexist

When both conditions are present simultaneously, the management requires addressing both the prolapse and the incontinence - either with a single combined surgical procedure or staged treatment - guided by careful preoperative evaluation.

Step 1: Preoperative Evaluation

Before planning treatment, it is essential to determine whether the SUI is:
  • Overt SUI - the patient already leaks with effort, and it is demonstrated clinically.
  • Occult (latent) SUI - the patient appears continent, but leaks are unmasked only when the prolapse is reduced (e.g., with a pessary, packing, or manual reduction). This occurs because advanced prolapse, especially a cystocele, can kink the urethra and create a functional obstruction that masks leakage. Treating the prolapse alone relieves this kink and can paradoxically cause de novo SUI in up to 25% of women with advanced prolapse.
A reduction stress test (urodynamics with prolapse reduced) is therefore a key part of preoperative workup and guides the decision to add a concomitant incontinence procedure.

Step 2: Surgical Treatment - Combined Approach

The guiding principle is to address both conditions at the same operation when SUI (overt or occult) is confirmed.

A. Abdominal / Laparoscopic Sacrocolpopexy + Burch Colposuspension

  • The landmark CARE (Colpopexy and Urinary Reduction Efforts) trial showed that performing a Burch colposuspension at the time of abdominal sacrocolpopexy significantly reduced postoperative SUI rates.
  • A "universal" continence procedure at the time of sacrocolpopexy is supported for women with Stage II-IV prolapse, regardless of the preoperative reduction stress test result.
  • Burch colposuspension: elevates the paravaginal tissue and bladder neck to the iliopectineal (Cooper's) ligament, restoring urethrovesical support.

B. Vaginal Prolapse Repair + Midurethral Sling (MUS)

  • For vaginal approach prolapse surgery, the OPUS (Outcomes Following Vaginal Prolapse Repair and Midurethral Sling) trial showed concomitant MUS (TVT/TOT) reduced rates of de novo postoperative SUI.
  • Women with overt SUI (demonstrated on exam with no contraindications) should have a concomitant sling at the time of vaginal prolapse repair.
  • Women with occult SUI only - a selective approach is preferred: sling is offered if occult SUI is detected on the reduction stress test, balancing benefit against sling-specific complications (bladder perforation, voiding dysfunction, UTI, bleeding).
  • When performing anterior colporrhaphy (for cystocele) with a midurethral sling, a separate incision should be made for the sling - the anterior repair should not be extended distally past the bladder neck.

C. Paravaginal Defect Repair + Sling

  • Abdominal paravaginal repair corrects lateral cystocele, with SUI cure rates of 85-97%.
  • If intrinsic sphincter deficiency (ISD) coexists, adding a pubovaginal sling (rectus fascial autograft) at the time of paravaginal repair improves SUI cure rates further (85% vs. 72% without sling).

Summary Table

Surgical RouteProlapse ProcedureConcomitant SUI Procedure
Abdominal / LaparoscopicSacrocolpopexyBurch colposuspension (CARE trial)
VaginalAnterior colporrhaphy / apical suspensionMidurethral sling (TVT or TOT) - selective or universal per clinical findings
AbdominalParavaginal defect repairPubovaginal sling (especially if ISD)

Non-Surgical Option

For women who are not fit for surgery or prefer to avoid it, a ring or shelf pessary can mechanically reduce the prolapse and simultaneously support the urethra, providing relief from both prolapse symptoms and SUI. This is first-line in elderly or medically unfit patients.

Key Clinical Points

  • Up to half of all women with SUI also have POP, so screening for both at every assessment is important.
  • Failure to recognize and treat prolapse at the time of SUI surgery increases the likelihood of repeat prolapse surgery (26% vs. 12% at 12 months, urologist vs. gynecologist data).
  • Voiding dysfunction coexisting with SUI warrants urodynamic evaluation before surgery, as the patient must be counseled about the possibility of persistent voiding problems postoperatively.
Sources: Campbell-Walsh-Wein Urology; Berek & Novak's Gynecology (CARE trial, OPUS trial data)
This is a shared conversation. Sign in to Orris to start your own chat.