Prediction and prevention of stress urinary incontinence after prolapse surgery

This thesis addresses the prediction and prevention of stress urinary incontinence (SUI) after pelvic organ prolapse (POP) repair. Risks and benefits of vaginal prolapse repair with and without midurethral sling (MUS) were studied in two randomized trials. A meta-analysis of recent literature including these trials showed that women with coexisting or occult SUI had a significant lower risk to undergo subsequent treatment for postoperative SUI (POSUI) after vaginal prolapse surgery with a MUS than after prolapse surgery only. However, serious adverse events occurred slightly more after vaginal prolapse repair with MUS. Data from the trials were also used for two prediction studies for POSUI. POSUI was defined as bothersome SUI or subsequent treatment for SUI after prolapse repair. We studied the predictive value of a positive stress test during basic office evaluation and urodynamics among women without SUI symptoms preoperatively. Women with a positive stress test were clearly more at risk to develop POSUI. Test performance did not improve with the adding of urodynamics. Pooling all women participating in the CUPIDO trials, we developed a prediction model for POSUI and studied the additional value of the stress test. The model showed that POSUI could be predicted fairly and that the stress test added no value in more than half of the women. Finally, we offered a conceptual model for weighing the pros and cons of combination surgery. According this concept, women with coexisting SUI should be offered combination surgery and the possibility should be discussed in women with occult SUI