title: Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach.
abstract: OBJECTIVE
  We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair.
  
  
  METHODS
  A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction.
  
  
  RESULTS
  The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%.
  
  
  CONCLUSIONS
  Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.
authors.affiliation: Department of Urology, New York University, New York, New York 10016, USA.
authors.forename: Katie N
authors.initials: KN
authors.lastname: Ballert
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Biggs
authors.forename: Anthony
authors.initials: A
authors.lastname: Isenalumhe
authors.forename: Nirit
authors.initials: N
authors.lastname: Rosenblum
authors.forename: Victor W
authors.initials: VW
authors.lastname: Nitti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014524:Urethral Obstruction / Q000175:diagnosis / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000601:surgery*