Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension.
OBJECTIVE
Our purpose was to compare two antiincontinence procedures in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence.


METHODS
In addition to cystopexy, 109 patients with a urethrocystocele of grade 2 or more and a positive stress test result with prolapse reduction received posterior pubourethral ligament plication or Pereyra suspension.


RESULTS
Of 55 patients undergoing posterior pubourethral ligament plication, 15 were clinically and 40 potentially incontinent; the same figures were 21 and 33, respectively, among 54 patients undergoing the Pereyra procedure. Follow-up was for 3 to 9 years. Subjective (60% vs 71%, p = 0.72) and objective (27% vs 57%, p = 0.14) cure rates were not statistically different among patients who were clinically incontinent (posterior pubourethral ligament plication vs Pereyra suspension). Among potentially incontinent patients, subjective (85% vs 100%, p = 0.03) and objective (50% vs 76%, p = 0.04) continence rates were higher after the Pereyra procedure. Overall, the cotton swab test had negative results (maximum straining angle < or = 30 degrees) after successful surgery in 79% and 96%, respectively, of patients (p = 0.03). Four subjects (7%) underwent removal of one Pereyra suture because of urinary retention or suprapubic wound infection.


CONCLUSIONS
Cystopexy with Pereyra suspension is recommended, particularly for patients with prolapse and potential stress incontinence.
Colombo
M
M
Department of Obstetrics and Gynecology, Third Branch of the University of Milan, San Gerardo Hospital, Monza, Italy.
Maggioni
A
A
Scalambrino
S
S
Vitobello
D
D
Milani
R
R
D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013536:Suture Techniques; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*