Protective effect of suburethral slings on postoperative cystocele recurrence after reconstructive pelvic operation.
OBJECTIVE
The purpose of this study was to evaluate the independent effect of suburethral sling placement on the risk of cystocele recurrence after pelvic reconstructive operation.


METHODS
One hundred forty-eight women with cystoceles to or beyond the hymenal ring underwent pelvic reconstructive operation, with or without incontinence procedures, and were evaluated at 12 and 52 weeks after operation with a standardized pelvic examination. Rates of recurrent prolapse, at all sites, were statistically compared between subjects with and without suburethral slings. A multiple regression analysis was used to determine the independent effect of sling placement on the risk of recurrent cystoceles.


RESULTS
Suburethral sling placement was associated with a 54.8% reduction in the mean rate of postoperative cystocele recurrence (P =.004). This protective effect was observed as early as 12 weeks and remained significant at 1-year follow up (42% vs 19%). A markedly reduced risk of cystocele recurrence was observed when women with sling procedures were compared with all other women, with those women who underwent other incontinence operations, and even with those women who had undergone prolapse repair with no incontinence procedure. The protective effect of the sling procedure remained highly significant (odds ratio, 0.29; P =.0003), even after controlling for potentially confounding variables in a multiple logistic regression model.


CONCLUSIONS
Suburethral sling procedures appear to significantly reduce the risk of cystocele recurrence after pelvic reconstructive operation, in contrast with the effect of retropubic urethropexy and needle suspensions. These findings should be considered when the surgical treatment of stress incontinence that accompanies pelvic organ prolapse is being planned.
Goldberg
R P
RP
Department of Evanston Continence Center, Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University Medical School, Evanston Northwestern Healthcare, Illinois, USA. rgoldberg@enh.org
Koduri
S
S
Lobel
R W
RW
Culligan
P J
PJ
Tomezsko
J E
JE
Winkler
H A
HA
Sand
P K
PK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D001745:Urinary Bladder Diseases / Q000150:complications / Q000517:prevention & control* / Q000601:surgery*; D014549:Urinary Incontinence / Q000150:complications / Q000601:surgery; D013520:Urologic Surgical Procedures; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery