title: Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial.
abstract: OBJECTIVE
  We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI).
  
  
  METHODS
  This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or greater POP. Women with occult SUI were randomly assigned to vaginal prolapse repair with or without MUS. Women without occult SUI received POP surgery. Main outcomes were the absence of SUI at the 12-month follow-up based on the Urogenital Distress Inventory and the need for additional treatment for SUI.
  
  
  RESULTS
  We evaluated 231 women, of whom 91 randomized as follows: 43 to POP surgery with and 47 without MUS. A greater number of women in the MUS group reported absence of SUI [86 % vs. 48 %; relative risk (RR) 1.79; 95 % confidence interval (CI) 1.29-2.48]. No women in the MUS group received additional treatment for postoperative SUI; six (13 %) in the control group had a secondary MUS. Women with occult SUI reported more urinary symptoms after POP surgery and more often underwent treatment for postoperative SUI than women without occult SUI.
  
  
  CONCLUSIONS
  Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.
authors.affiliation: Department of Obstetrics and Gynaecology, Martini Hospital, PO Box 30.033, 9700 RM, Groningen, The Netherlands. PloegJM@mzh.nl.
authors.forename: J Marinus
authors.initials: JM
authors.lastname: van der Ploeg
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22.660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Katrien
authors.initials: K
authors.lastname: Oude Rengerink
authors.affiliation: Department of Obstetrics and Gynaecology, Ziekenhuisgroep Twente, PO Box 546, 7550 AM, Hengelo, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: van der Steen
authors.affiliation: Department of Obstetrics and Gynaecology, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
authors.forename: Jules H Schagen
authors.initials: JH
authors.lastname: van Leeuwen
authors.affiliation: Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, PO Box 85.500, 3508 GA, Utrecht, The Netherlands.
authors.forename: C Huub
authors.initials: CH
authors.lastname: van der Vaart
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22.660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Jan-Paul W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011788:Quality of Life; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
keywords: Masked; Midurethral sling; Occult; Pelvic organ prolapse; Randomised; Stress urinary incontinence