title: Effects of pelvic organ prolapse repair on urinary symptoms: a comparative study between the laparoscopic and vaginal approach.
abstract: OBJECTIVE
  To compare changes in urinary symptoms before and after pelvic organ prolapse (POP) surgery, using either laparoscopic sacrocolpopexy (LSC) or transvaginal porcine dermis hammock placement with sacrospinous ligament suspension (VS).
  
  
  METHODS
  Data were prospectively collected from all women undergoing POP surgery between May 2001 and October 2009. Pre- and postoperative urinary symptoms, Urinary Distress Inventory (UDI), and Urinary Impact Questionnaires (UIQ) scores were compared within and between groups. A generalized linear model was used for multivariate analysis.
  
  
  RESULTS
  Out of the 151 patients included, 87 patients underwent LSC, and 64 VS. Overall, after a median follow-up of 32.4 months, POP surgery improved urinary frequency (P = 0.006), voiding difficulty (P = 0.001), stress urinary incontinence (SUI) (P = 0.001), but not urgency (P = 0.29). VS was more effective in treating SUI (P < 0.001 vs. 0.52) while LSC more effective on voiding difficulty (P = 0.01 vs. 0.08). Postoperative de novo symptoms were observed in 35.8% of patients with no difference between the groups (P = 0.06). UDI (P = 0.04) and UIQ (P = 0.01) scores were significantly lower after surgery. However, LSC significantly improved UDI (P = 0.03) with no effect on UIQ (P = 0.29) scores while VS significantly improved both scores (P = 0.02 and 0.001, respectively). Upon multivariate analysis, only the improvement in the impact of urinary symptoms on daily living was independently associated to VS (OR = 5.45 [95% confidence interval 2.20-13.44], P = 0.01).
  
  
  CONCLUSIONS
  Most preoperative urinary symptoms decreased after POP surgery with equivalent proportion of de novo symptoms after vaginal and laparoscopic approaches.
authors.affiliation: Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Ramanah
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Chereau
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology* / Q000209:etiology*; D014621:Vagina