title: [Impact of laparoscopic sacrocolpopexy, with or without a midurethral sling, on lower urinary tract symptoms].
abstract: OBJECTIVE
  To evaluate the impact of laparoscopic sacrocolpopexy, with or without simultaneous midurethral sling (MUS), on urinary symptoms and health-related quality of life of patients.
  
  
  METHODS
  A prospective analysis was carried out including 83 women with symptomatic pelvic organ prolapse who had laparoscopic sacrocolpopexy between 2009 and 2011. Patients were classified according to the preoperative clinical examination (stress test). Thirty patients with patent (group A) stress urinary incontinence (SUI) and 15 patients with occult SUI (group B) had a MUS associated with sacrocolpopexy. Thirty-eight patients with negative stress test (group C) were treated by sacrocolpopexy without MUS, even if they had history of SUI. At each visit, urinary symptoms (UDI-6) and their impact on quality of life (UIQ-7) were evaluated using validated self-questionnaires, Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire.
  
  
  RESULTS
  After 3years of mean follow-up, SUI was improved in 22/30 (77%) of patients in group A and only one patient needed a second MUS. Dysuria was cured in 9/12 (75%), 5/7 (71%) and 16/19 (84%) of patients of groups A, B, C respectively and urge urinary incontinence in 13/19 (68%), 2/2 (100%) and 4/6 (67%) of patients. The rate of de novo urge incontinence was respectively 1/11 (9%), 2/13 (15%) and 6/32 (19%). De novo SUI appeared in 6/32 (19%) of patients in group C, but only 2 of them secondarily needed a MUS. After 3 years, our study showed a significant decrease of UDI-6 of 62, 63 and 48% comparing with preoperative score and of UIQ-7 of 77, 54 and 81%.
  
  
  CONCLUSIONS
  Laparoscopic sacrocolpopexy associated with MUS for patent stress urinary incontinence improves significantly stress and urgency urinary incontinence. Laparoscopic sacrocolpopexy without MUS, when physical exam shows a negative stress test, significantly reduces voiding difficulties with very few cases of de novo stress and urge incontinence.
  
  
  METHODS
  4.
authors.affiliation: Service de gynécologie-obstétrique, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France. Electronic address: salerno_jennifer@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Salerno
authors.affiliation: Service de gynécologie-obstétrique, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: R
authors.initials: R
authors.lastname: de Tayrac
authors.affiliation: Service d'urologie, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: S
authors.initials: S
authors.lastname: Droupy
authors.affiliation: Service d'urologie, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: P
authors.initials: P
authors.lastname: Costa
authors.affiliation: Service d'urologie, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: E
authors.initials: E
authors.lastname: Llinares
authors.affiliation: Service de gynécologie-obstétrique, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: B
authors.initials: B
authors.lastname: Fatton
authors.affiliation: Service d'urologie, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
authors.forename: L
authors.initials: L
authors.lastname: Wagner
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D012447:Sacrum; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014621:Vagina
keywords: Bandelette sous-urétrale; Incontinence urinaire d’effort; Laparoscopic sacrocolpopexy; Pelvic organ prolapse; Prolapsus; Promonto-fixation cœlioscopique; Stress urinary incontinence; Suburethral sling