Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing

Abstract

The objectives of this study were to evaluate the incidence of postoperative stress urinary incontinence (SUI) after laparoscopic sacrocolpopexy (LSCP) in women with negative preoperative prolapse reduction stress testing (PPRST) and to identify associated risk factors. This was a retrospective cohort study comprising women who consecutively underwent double-mesh LSCP without concomitant SUI surgery after a negative PPRST at a tertiary referral center. Negative PPRST was defined by the absence of SUI during cough testing and urodynamic studies with prolapse reduction. Fifty-five patients were assessed in the final analysis. No significant complication was encountered during and after LSCP. Mean follow-up was 25 ± 11 (range 12-48) months. No patient developed recurrent pelvic organ prolapse (POP) or mesh erosion at last follow-up. Thirty (54.5 %) patients reported the symptom of SUI (subjective SUI) postoperatively, 13 (23.6 %) had a positive cough test (objective SUI) at last visit, and nine (16.4 %) underwent a sling procedure. In univariate analyses, advanced cystocele (stage 3-4) and a history of patient-reported SUI before surgery were associated with a higher risk of postoperative subjective and objective SUI after LSCP. Multivariate analyses identified preoperative SUI as the sole independent predictor of subjective SUI [risk ratio (RR = 4.03; 95% confidence interval (CI) = 1.16-14.09), objective SUI, (RR = 4.67; 95% CI = 1.14-19.23), and subsequent anti-SUI surgery after LSCP (RR = 6.17; 95% CI = 1.30-29.41). SUI is far from uncommon in women after LSCP despite negative PPRST, especially in those with advanced cystocele and a history of SUI preoperatively; after at least 1 year of follow-up, approximately one in six women eventually underwent a sling surgery. These data are useful for counseling patients.