Are Anti-Incontinence Procedures Indicated in All Women Undergoing Colpocleisis?

Abstract

Study Objective: The purpose of this study is to determine if anti- incontinence procedures are indicated in all women undergoing colpocleisis or colpectomy. Design: A retrospective chart review of women undergoing either a colpocleisis or colpectomy procedure from December 2004 to December 2007. We identified 103 women, and 8 excluded for missing data. Our inclusion criteria included anyone having colpocleisis or colpectomy. The women underwent an incontinence surgery if preoperative urodynamics testing identified Urodynamic Stress Incontinence (USI). Baseline data included stage of prolapse, urodynamics results, concomitant surgical procedures including midurethral sling, and postoperative continence. Incontinence symptoms were compared between women who had slings placed and those that did not. Data was analyzed with Pearson's Chi Square. Setting: n/a Patients: n/a Intervention: n/a Measurements and Main Results: Of the 95 women, 54% had USI and underwent a concomitant midurethral sling placed and 46% did not have USI therefore did not undergo sling. In the group who had a sling procedure, 67% (34/51) were found to be continent of urine at their postoperative visit and 33% (17/51) incontinent. While 75% (33/44) of the group without sling placement were continent and 25% (11/44) incontinent. The differences between groups were not statistically significant (p = 0.374). The continence outcome recorded in the first postoperative visit.Tabled 1The continence outcome recorded in the first postoperative visitConcomitant sling (n = 51)No concomitant sling (n = 44)SignificanceAny post op Incontinence 6 week visit17/51 (33%)11/44 (25%)p = 0.374Any post op incontinence long term visit (mean 37 weeks)17/31 (55%)18/27 (67%)p = 0.100 Open table in a new tab Longer term follow-up, 37 weeks, was available for 58 women. Within the sling group 45% (14/31) continued to be continent, while more women reported incontinence at 55% (17/31). The group who did not receive a sling had a 67% (18/27) incontinence rate, and 33% (9/27) continent (p = 0.100). Conclusion: Selective use of midurethral sling in women undergoing colpocleisis or colpectomy leads to similar results in subjective reports of any incontinence postoperatively. There were not larger numbers of women reporting incontinence in the group who did not undergo sling, suggesting that offering a midurethral sling to all women undergoing obliterative surgery may not be beneficial; however, this will need to be studied further.