title: Now or later...Does timing of a midurethral sling in relation to transvaginal prolapse repair affect continence outcomes at 1 year?
abstract: OBJECTIVE
  : To determine if timing of a midurethral sling (MUS) relative to prolapse repair affects continence.
  
  
  METHODS
  : Continence outcomes were compared in women with stress urinary incontinence (SUI) undergoing prolapse repair with Prolift. Groups included concomitant procedure (CP) and planned staged procedure (PSP). Continence was assessed by validated questionnaires and satisfaction by visual analog scale (0-10).
  
  
  RESULTS
  : Twenty women underwent CP and 29 underwent PSP. One year after prolapse repair, 66% in the PSP group did not pursue MUS. Still, there were no significant differences at 1 year between groups in subjective SUI (CP = 22.2%, PSP = 21.4%), change in the severity of SUI (Urinary Distress Inventory: ΔPSP = -56.1, ΔCP = -59.7; Urinary Impact Questionnaire: ΔPSP = -47.1, ΔCP = -48) or satisfaction (CP = 8.8, PSP = 9.2).
  
  
  CONCLUSIONS
  : A staged approach for treatment of SUI after prolapse repair appears to result in comparable continence and satisfaction outcomes to concomitant MUS placement 1 year after prolapse surgery despite 2/3 of women not pursuing MUS. Appropriately powered trials are warranted to confirm the potential benefits of a decreased need for incontinence surgery with a planned staged approach.
authors.affiliation: From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA; and †Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente, West Los Angeles, Los Angeles, CA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
authors.forename: Marianna
authors.initials: M
authors.lastname: Alperin
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Meyn
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Frankman
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski