Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: tension free slings with colporrhaphy, or Prolift with the tension free midurethral sling?

OBJECTIVE

Comparison of procedures in patients with concomitant stress urinary incontinence (SUI) and pelvic organ prolapse (POP) was performed. Tension free vaginal tape (TVT) or transobturator tape (TOT) with colporrhaphy was compared with fixed mesh (Prolift) applied with a tension free suburethral sling.

STUDY DESIGN

A total of 76 women with both SUI and POP were evaluated. TVT or TOT with colporrhaphy was performed in 39 patients and Prolift with the midurethral sling in 37 patients. Anatomy, symptoms and quality of life (QOL) were evaluated prior to, and at 1, 6 and 12 months after surgery.

RESULTS

Continence was achieved in both groups equally (p=0.57). The better anatomic outcome regarding the correction of POP was in the Prolift group but with a higher rate of additional procedures and complications. QOL was better in patients with grade III-IV POP corrected with Prolift (p=0.05) and equal in both groups with grade I-II POP during the follow-up. Impairment of sexual life was present in both groups before surgery. After surgery, there was no improvement in sexual life regardless of correction of both anatomy and incontinence.

CONCLUSION

Both procedures are effective and safe. TVT or TOT performed with colporrhaphy looks a better primary choice for grade II POP and SUI. Results for grade III-IV POP and SUI are better with the Prolift with the sling. Sexual life could not be improved effectively with these types of surgery.