Genital prolapse and stress incontinence: Conservative and operative approaches

Bladder dysfunction including stress urinary incontinence is common in women with pelvic organ prolapse. Pelvic floor exercises and pessaries may be successful in alleviating prolapse and incontinence symptoms. After anterior repair, 48% of preoperatively stress incontinent women are continent, 61% after transobturator mesh operations. Additional suburethral sling insertion considerably increases postoperative continence rates. In women with occult stress incontinence, concomitant placement of a suburethral tape also improves success rates for stress incontinence. The subethral sling may be inserted concomitantly or three months after prolapse surgery with similar results. However, nearly one third of women declined the suburethral tape because they were dry after anterior repair. Continent women with prolapse develop stress incontinence in 9% after anterior repair and in 14% after transobturator mesh implantation. In summary, women with occult or symptomatic stress incontinence benefit from additional suburethral tape insertion. However, almost one third of women will receive an unnecessary operation and delayed continence surgery should be considered