title: Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review.
abstract: OBJECTIVE
  Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively.
  
  
  METHODS
  A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ).
  
  
  RESULTS
  Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36).
  
  
  CONCLUSIONS
  Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.
authors.affiliation: Discipline of Gynecology, School of Medicine, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255, 10° andar, Cerqueira César, 05403-000, São Paulo, SP, Brazil, pri.matsuoka@gmail.com.
authors.forename: Priscila Katsumi
authors.initials: PK
authors.lastname: Matsuoka
authors.forename: Aparecida Maria
authors.initials: AM
authors.lastname: Pacetta
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
authors.forename: Jorge Milhem
authors.initials: JM
authors.lastname: Haddad
mesh_terms: D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000517:prevention & control*