Under what circumstances should stress incontinence surgery be performed at the same time as prolapse surgery? ICI-RS 2015.

AIMS

An International Consultation on Incontinence-Research Society (ICI-RS) Think Tank in 2015 discussed and evaluated the evidence of when stress incontinence surgery should be performed with prolapse surgery and highlighted evidence gaps, with the aim of recommending further clinical and research proposals.

METHODS

A review of the literature assessing randomized studies where women with vaginal prolapse have been randomized to vaginal prolapse surgery with or without continence surgery were evaluated. The different clinical presentations were also evaluated and their impact on outcome was critically reviewed.

RESULTS

There are three symptomatic groups of women with vaginal prolapse who are treated. The first group is continent women with vaginal prolapse. The second group has stress urinary incontinence (SUI) and vaginal prolapse. The last group has vaginal prolapse and have been found through testing to have occult SUI. The studies have reported a range of outcomes for each of these groups. There are different outcomes based on the surgical method used to correct the prolapse and also the different continence surgical techniques. There are insufficient studies to allow firm conclusions to be drawn. The economic impact of the different management pathways is also discussed although costs vary according to different national medical funding systems.

CONCLUSIONS

There is considerable uncertainty about the optimal method of managing women with vaginal prolapse and stress incontinence due to the different surgical techniques available. In particular the group of women with occult SUI are a challenge as the optimal diagnostic method has not yet been defined.