title: To sling or not to sling at the time of anterior vaginal compartment repair.
abstract: OBJECTIVE
  Prevention of postoperative stress urinary incontinence at the time of prolapse repair is controversial. There has been a shift away from colposuspension procedures to midurethral slings. As with any surgery, midurethral slings are associated with risks, which must be balanced against the benefits of preventing postoperative stress urinary incontinence. The aim of this overview is to review the controversy, discuss potential complications of midurethral slings, discuss the efficacy of concomitant sling placement, and suggest a method of systematically approaching patients with high-grade anterior compartment prolapse.
  
  
  RESULTS
  Several studies have recently advocated for the routine use of anti-incontinence procedures at the time of prolapse surgery; however, applying these data to midurethral slings is problematic. Ultimately, the issue of treatment of the urethra at the time of prolapse repair should be discussed with the patient with treatment rendered depending on the risk the patient is willing to bear.
  
  
  CONCLUSIONS
  The aim of this study is to discuss the risks and benefits of applying a midurethral sling in patients with high-grade anterior compartment prolapse. In these patients, placement of a suburethral sling may be approached systematically, taking into account the patients' variables and their own goals of therapy.
authors.affiliation: Department of Urology, Louisiana State University Health Sciences Center, Ochsner Clinic Foundation, New Orleans, Louisiana, USA. jtogami@ochsner.org
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Togami
authors.forename: Denise
authors.initials: D
authors.lastname: Chow
authors.forename: J Christian
authors.initials: JC
authors.lastname: Winters
mesh_terms: D005260:Female; D006801:Humans; D007258:Informed Consent; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*