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|Title:||Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial|
|Author:||van der Ploeg, J.|
Oude Rengerink, K.
van der Steen, A.
van Leeuwen, J.
van der Vaart, C.
|Citation:||BJOG, 2015; 122(7):1022-1030|
|JM van der Ploeg, K Oude Rengerink, A van der Steen, JHS van Leeuwen, J Stekelenburg, MY Bonger, M Weemhoff, BW Mol, CH van der Vaart, J-PWR Roovers, on behalf of the Dutch Urogynaecology Consortium|
|Abstract:||Fourteen teaching hospitals in the Netherlands. POPULATION: Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. METHODS: Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. MAIN OUTCOME MEASURES: The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. RESULTS: One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54). CONCLUSIONS: Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women|
|Keywords:||Midurethral sling; pelvic organ prolapse; randomised; stress urinary incontinence|
|Rights:||© 2015 Royal College of Obstetricians and Gynaecologists|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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