Treatment of concomitant prolapse and stress urinary incontinence via a transobturator subvesical mesh without independent suburethral tape.
OBJECTIVE
Evaluate the efficacy of a transobturator subvesical mesh for cystocele in concomitant stress urinary incontinence (SUI).


METHODS
Longitudinal observational study.


METHODS
Tertiary referral urogynecology center.


METHODS
One hundred and five women with at least an anterior vaginal wall prolapse and concomitant SUI who underwent surgery.


METHODS
After reduction of prolapse elements, the intervention consisted of a non-absorbable monoprosthesis placement with two transobturator expansions and, if necessary, associated hysterectomy or infraccocygeal sacropexy. No specific procedure was performed for SUI.


METHODS
All patients had a physical examination and a subjective symptoms assessment via questionnaire in the preoperative period and at one-year or more after surgery. The pelvic organ prolapse quantification system was used for anatomical results. For SUI, Ingelman-Sundberg classification and cough test were used. Loss of urine was measured by a one-hour pad test. Functional results were evaluated by visual analog scale, quality-of-life questionnaires, including the pelvic floor distress inventory and the pelvic floor impact questionnaire.


RESULTS
Median follow-up was 45 months (range: 12-72). A total of 102 women (97%) were cured of their prolapse, of whom 72 (69%) were cured of their SUI and 13 (12%) showed improvement. Pad test, visual analogic scale and quality-of-life questionnaires were all improved (p < 0.05). Complications consisted of one rectal injury, one transitory urinary retention, and two hematomas. Of the erosions 6% was observed for monofilament polypropylene prostheses.


CONCLUSIONS
Transvaginal monoprosthesis for the simultaneous correction of prolapse and SUI represents an effective treatment for bulky or recurrent prolapse as well as posthysterectomy vaginal vault prolapse.
Sergent
Fabrice
F
Department of Obstetrics and Gynecology, Rouen University Hospital, 1, rue de Germont-76031 Rouen Cedex, France. Fabrice.Sergent@chu-rouen.fr
Sentilhes
Loïc
L
Resch
Benoît
B
Verspyck
Eric
E
Medeiros
Richard
R
Descamps
Philippe
P
Marpeau
Loïc
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*