Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview.

Postoperative SUI prevention at the time of prolapse surgery is still a challenging issue. Recent findings suggested that a systematic prophylactic Burch colposuspension could be performed in continent women undergoing a sacral colpopexy. The aim of this paper is to collect relevant literature in order to suggest a management strategy. A thorough PubMed research of all papers in the English language was conducted. Evidence-based medicine was analyzed and current unanswered questions were discussed. Despite evident limitations, it appears to be some benefit from preoperative screening with a stress test during prolapse reduction. In continent patient with a positive stress test, adding a preventive procedure could be fully justified. In regard to contradictory published data, when negative stress test, patient counseling is important and the ratio of risk-benefit should be rigorously discussed. Further randomized controlled studies are needed to support either a prophylactic or a second-step strategy.