title: Occult Stress Urinary Incontinence in Women With Pelvic Organ Prolapse: Is the One Step Surgical Approach a Risky Choice?
abstract: OBJECTIVE
  Occult stress urinary incontinence (SUI, OSUI) is defined as the demonstration of SUI after pelvic organ prolapse (POP) reduction. The aim of this study was to evaluate the effectiveness and complication rates of the 1-step surgical approach for treating women with POP and OSUI.
  
  
  METHODS
  Retrospective study of women with POP and OSUI who underwent a concomitant prolapse and midurethral sling procedure was conducted. Main outcome measures were absence of postoperative urodynamic stress incontinence (USI) and absence of postoperative SUI at 12 months. Secondary outcome measures included evaluation of objective and subjective parameters related to the lower urinary tract function and assessment of the quality of life.
  
  
  RESULTS
  Of the 244 women, 205 women (84%) attended the 12-month postoperative follow-up visit and were included in the study. Overall, 87.8% (180/205) of the patients had absence of postoperative urodynamic stress incontinence, whereas 95.1% (195/205) did not report postoperative SUI. Evaluation of parameters related to the postoperative lower urinary tract dysfunction showed that (a) 43% of women with preexisting urgency symptoms continued to have urgency, (b) 16.7% of patients presented de novo urgency, (c) de novo detrusor overactivity occurred in 9.3% of patients, and (d) 4.9% of women with preoperative obstructive voiding symptoms continued to have obstructive voiding symptoms after combined surgery. King's Health Questionnaire data analysis showed a statistically significant improvement in all domains.
  
  
  CONCLUSIONS
  This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.
authors.affiliation: From the *First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece; and †Obstetrics and Gynaecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zacharakis
authors.forename: Themos
authors.initials: T
authors.lastname: Grigoriadis
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kastanias
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannoulis
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.forename: Stavros
authors.initials: S
authors.lastname: Athanasiou
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*