Continence surgery at the time of pelvic organ prolapse repair: a review of the literature

Abstract

Key content Pelvic organ prolapse and incontinence are significant health problems; one in nine women are affected by prolapse and one in three by stress urinary incontinence. Pelvic floor muscle training remains the first‐line treatment for stress urinary incontinence. Concomitant surgical correction for coexisting symptomatic prolapse and incontinence is an option for treatment, but persistent postoperative incontinence can be challenging to manage. Delayed or interval continence procedures may be beneficial and should be discussed with women preoperatively. Learning objectives To understand the health burden and prevalence of pelvic organ prolapse and incontinence in the population. To understand the surgical treatment options available. To learn about the advantages and disadvantages of concomitant surgery in patients with symptomatic or occult stress incontinence and in those who are continent. Ethical issues Should transvaginal prolapse repair and concomitant synthetic miduretheral sling be offered to women without stress urinary incontinence? Should all women be preoperatively screened for occult stress urinary incontinence, given its prevalence and implications for postoperative outcomes?