Role of prophylactic midurethral sling in preventing post-operative stress urinary incontinence following repair of anterior vaginal wall prolapse

Abstract

Objective: This study was conducted to find whether, among women without preoperative stress incontinence who underwent surgery for repair of anterior vaginal wall prolapse, the placement of a prophylactic midurethral mesh along with the prolapse correction surgery helped to reduce the incidence of post-operative stress urinary incontinence (POSUI). Materials & Methods: 145 women with anterior vaginal compartment prolapse were randomly assigned to receive either suitable corrective surgery for prolapse or corrective surgery along with concurrent placement of a prophylactic midurethral sling by a transobturator Prolene tape. The primary endpoint was urinary incontinence at three months and twelve months post surgery. Secondary outcomes included expected and unexpected adverse events. Results: At three months follow up the symptoms of urinary incontinence and/or positive cough test did not differ significantly between the two groups. But at twelve months, both the symptoms of urinary incontinence (9.59% versus 23.61%, p = 0.025, 95% CI = -25.93% to -2.11%, CMLE OR =0.346) and positive cough test (8.22% versus 25%, p = 0.007, 95% CI = -28.60% to -4.96%, CMLE OR = 0.271) were significantly lower in the study group compared to the control group. Expected and unexpected adverse events during operation and through the first year after surgery were comparable in both groups Conclusion: Placement of a midurethral sling by a Prolene mesh at the time of prolapse repair surgery significantly reduces the incidence of POSUI in women who were continent preoperatively. For this, the transobturator tape method is safe and effective with a low rate of complications.