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AUA 2018

AUA 2018: Is Prophylactic Stress Incontinence Surgery Necessary at the Time of Pelvic Organ Prolapse Repair?

San Francisco, CA (UroToday.com) The CARE trial demonstrated that greater than 57% of women without stress urinary incontinence (SUI) who undergo abdominal sacrocolpopexy will develop SUI post-operatively.1 This has led some surgeons to perform prophylactic anti-incontinence procedures at the time of prolapse repair. However, many women who develop SUI after prolapse repair may not need treatment if the symptoms are not bothersome enough, which may subject them to the inherent risks of these procedures unnecessarily. The authors here further explore the question of whether prophylactic anti-incontinence procedures are necessary using a large population database. 


The authors used the Office of Statewide Health Planning and Development (OSHPD) Databse, which contains information form every inpatient admission, surgery, and ambulatory surgery in the state of California. They identified women who underwent apical and/or anterior compartment prolapse repair without a concomitant anti-incontinence procedure from 2005 to 2011. Of these patients they examined the proportion who underwent an incontinence procedure during the follow up period and identified factors associated with this. 

The database identified greater than 41,000 women who underwent prolapse repair without an anti-incontinence procedure. 47% had anterior repair only, 28% had apical repair only, and 25% had combined anterior and apical repair. The mean follow up time was 4.1 years.  3.6 % of patients underwent a subsequent SUI procedure. Multivariate analysis showed patients who were Asian or Black were less likely to undergo a subsequent SUI procedure, while obesity, Diabetes, Caucasian race, and use of mesh at index surgery were associated with an increased likelihood of subsequent SUI procedure. 

This was an important study that identified a very small proportion of patients  (only 3.6%) who underwent prolapse repair without an anti-incontinence procedure, had a subsequent SUI procedure. The authors identified several variables associated with increased or decreased likelihood of this, with race being a prominent factor on multivariate analysis. The reasons for this are complex but are likely multifactorial and may indicate a need to examine access to care more closely.  Overall, the authors demonstrate findings, consistent with previous literature, that show a prophylactic SUI procedure at the time of prolapse repair is likely unnecessary in many patients. 

Presented By: Raveen Syan, MD; Stanford University 

References: 
1. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557-1566. 

Written by: Dena Moskowitz, MD; Fellow, Female Pelvic Medicine and Reconstructive Surgery, Virginia Mason Medical Center Twitter: @demoskowitz at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA