title: [Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence].
abstract: OBJECTIVE
  To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence (OSUI) during reductive surgery for advanced pelvic organ prolapse (POP).
  
  
  METHODS
  From Jun. 2003 to Dec. 2012, 78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension, sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital, General Hospital of People's Liberation Army. Among them, 41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape (TVT) or tension-free vaginal tape-obturator technique (TVT-O) was in anti-incontinence group. The patient's demography, objective and subjective outcomes, as well as complications and injures were compared between the two groups. The pelvic organ prolapse quantitation (POP-Q) was used to evaluate the objective outcomes of POP. Urinary distress inventory (UDI-6) and incontinence impact questionnaire short form (IIQ-7) were used to evaluate the subjective outcomes of stress urinary incontinence (SUI).
  
  
  RESULTS
  Compared with the non-concomitant anti-incontinence group, the objective outcomes of reductive surgery exhibited no significant differences (100%, 78/78), and only the operation time of anti-incontinence group slightly increased 16 minutes. The occurrence rate of postoperative SUI was 12% (5/41), 15% (6/41), 17% (7/41) respectively after the operation at 2-month, 6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% (1/37), 3% (1/37), 3% (1/37); but none of patients in the two groups require further surgery for stress urinary incontinence. Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month, 6-month and 12-month follow up (all P < 0.01). However, there was no statistic difference between the two groups (P > 0.05).
  
  
  CONCLUSIONS
  It is still difficult to make decision for concomitant anti-incontinence procedure in those patients with OSUI, who are undergoing reductive surgery because of advanced POP. Whether the patients will benefit more from anti-incontinence sling depends largely on strict preoperative evaluation for the severity of SUI. The patients with severe SUI are supposed to benefit most from anti-incontinence sling. However, a two-step approach to correct the postoperative stress urinary incontinence is also reasonable.
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China. Email: yongxianlu@sina.com.
authors.forename: Yongxian
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Shen
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Ge
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Niu
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Wenying
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Chengli
authors.initials: C
authors.lastname: Qiu
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008022:Ligaments; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011184:Postoperative Period; D012447:Sacrum / Q000601:surgery; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*