title: Lack of effect of concomitant stage II cystocele repair on lower urinary tract symptoms and surgical outcome after tension-free vaginal tape procedure: randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to compare the lower urinary tract symptom changes and surgical outcome between the tension-free vaginal tape (TVT) procedure with and without concomitant stage II pelvic organ prolapse (cystocele) repair in a randomized clinical trial setting.
  
  
  METHODS
  Patients with urodynamically proven stress urinary incontinence (SUI) and asymptomatic stage II cystocele were randomly and equally allocated to either a TVT and concomitant cystocele repair group or TVT only group. SUI was corrected with TVT in all cases. The cystocele repair procedure was performed with Gynemesh. Lower urinary tract symptoms and surgical outcome were assessed at postoperative year 1. Lower urinary tract symptoms were assessed with the American Urological Association Symptom Score (AUASS) questionnaire, uroflowmetry, and postvoid residual (PVR).
  
  
  RESULTS
  The cure rate of TVT only and the concomitant repair group was 87 and 91%, respectively (p > 0.05). Cystocele was cured in all patients in the concomitant repair group. After the operation, the total AUASS were 6.4 and 8.4 in the TVT only group and concomitant repair group, respectively, with no statistical difference. There was no difference in the change in peak flow rate (Qmax) and PVR between the two groups. The prevalence of postoperative mixed incontinence was not different between the two groups.
  
  
  CONCLUSIONS
  In patients with stage II cystocele and SUI, there was no difference in the surgical outcome and lower urinary tract symptoms between the TVT sling only group and concomitant repair group. Cystocele repair can be safely omitted in patients with stage II cystocele.
authors.affiliation: Department of Urology, School of Medicine, Konkuk University, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea.
authors.forename: Hyoung Keun
authors.initials: HK
authors.lastname: Park
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Paick
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Lho
authors.forename: Gwoan Youb
authors.initials: GY
authors.lastname: Choo
authors.forename: Hyeong Gon
authors.initials: HG
authors.lastname: Kim
authors.forename: Jaekyung
authors.initials: J
authors.lastname: Choi
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D052858:Cystocele / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D053825:Suburethral Slings