[Treatment of Urinary incontinence associated with genital prolapse: Clinical practrice guidelines].
BACKGROUND
Prolapse and urinary incontinence are frequently associated. Patente (or proven) stress urinary incontinence (SUI) is defined by a leakage of urine that occurs with coughing or Valsalva, in the absence of any prolapse reduction manipulation. Masked urinary incontinence results in leakage of urine occurring during reduction of prolapse during the clinical examination in a patient who does not describe incontinence symptoms at baseline. The purpose of this chapter is to consider on the issue of systematic support or not of urinary incontinence, patent or hidden, during the cure of pelvic organs prolapse by abdominal or vaginal approach.


METHODS
This work is based on an systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane database of systematic reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement).


RESULTS
In case of patent IUE, concomitant treatment of prolapse and SUI reduces the risk of postoperative SUI. However, the isolated treatment of prolapse can treat up to 30% of preoperative SUI. Concomitant treatment of SUI exposed to a specific overactive bladder and dysuria morbidity. The presence of a hidden IUE represents a risk of postoperative SUI, but there is no clinical or urodynamic test to predict individually the risk of postoperative SUI. Moreover, the isolated treatment of prolapse can treat up to 60% of the masked SUI. Concomitant treatment of the hidden IUE therefore exposes again to overtreatment and a specific overactive bladder and dysuria morbidity.


CONCLUSIONS
In case of overt or hidden urinary incontinence, concomitant treatment of SUI and prolapse reduces the risk of postoperative SUI but exposes to a specific overactive bladder and dysuria morbidity (NP3). The isolated treatment of prolapse often allows itself to treat preoperative SUI. We can suggest not to treat SUI (whether patent or hidden) at the same time, providing that women are informed of the possibility of 2 stages surgery (Grade C). © 2016 Published by Elsevier Masson SAS.
Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, Paris, France. Electronic address: ariane.cortesse@sls.aphp.fr.
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Cortesse
Département d'urologie, pôle de santé du Plateau, 3, avenue de Villacoublay, 92360 Meudon, France.
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Cardot
Clinique de Bercy, 9, quai de Bercy, 94220 Charenton-le-Pont, France.
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Basset
Service urologie, CHU Nantes, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
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Le Normand
Polyclinique Côte Basque Sud, 7, rue Léonce-Goyetche, 64500 Saint-Jean-de-Luz, France.
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Donon
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000592:standards*; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D014550:Urinary Incontinence, Stress / Q000150:complications* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
Guidelines; Incontinence urinaire; Pelvic organ prolapse; Prolapsus génital; Recommandations; Surgical treatment; Traitement chirurgical; Urinary incontinence