New Study Explores Findings of Long-Term Urinary Outcomes After Pelvic Organ Prolapse Repair
July 20, 2022
A study published in March 2022 in the Female Pelvic Medicine & Reconstructive Surgery journal explored long-term urinary outcomes in women who underwent transvaginal surgery for uterovaginal prolapse. The study examined 5-year outcomes of participants in the Pelvic Floor Disorders Network Study of Uterine Prolapse Procedures Randomized Trial (SUPer), whose repair was performed with or without a concomitant midurethral sling.
UPMC Magee-Womens Hospital physician Lauren Giugale, MD, assistant professor in the Division of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine, was the study's first author. The senior author of the multicenter study was Halina Zyczynski, MD, professor and chair of the Department of Obstetrics and Gynecology at UPMC Hamot and director of Erie operations of Magee-Womens Research Institute.
This secondary analysis of a large, multicenter randomized trial of vaginal procedures for pelvic organ prolapse explored urinary outcomes of women after transvaginal hysteropexy with mesh graft (uterine suspension) or the traditional vaginal hysterectomy with uterosacral ligament suspension. The Urinary Distress Inventory Score (UDI-6) was used to determine if there were differences in urinary symptoms between those who received a midurethral sling and those who did not at the time of prolapse repair.
“There is uncertainty in the field about whether or not a miduretheral sling placed at the time of prolapse repair confers treatment benefits for urinary incontinence,” says Dr. Giugale. “In some instances, a staged or delayed decision to place a sling may be optimal as bladder control can spontaneously improve in the months after prolapse repair. This study was designed to provide needed data on this relationship.”
The sling cohort comprised 90 women, 43 with hysteropexy, and 47 with hysterectomy. The non-sling group included 93 women, 48 had a hysteropexy and 45 had hysterectomies.
In their analysis, Dr. Giugale and colleagues found several significant outcome differences.
For women who underwent hysteropexy with mesh, the addition of a concomitant midurethral sling did not confer improved bladder function when compared to those who did not receive the sling.
However, for individuals undergoing a non-mesh augmented vaginal hysterectomy with uterosacral ligament suspension, there was a distinct difference in long-term urinary outcomes scores between the sling and non-sling groups. Women who received a concomitant sling reported better urinary outcomes over time.
Small proportions of women in both the sling (6-19%) and non-sling (24-27%) groups reported new or worsening stress urinary incontinence. Of those women with new or worsening stress urinary incontinence, 40% underwent some sort of treatment over the study’s 5-year follow-up period.
“While additional studies are needed to further explore and expand upon our findings, it does appear that the type of prolapse surgery can influence urinary outcomes after concomitant sling procedures,” says Dr. Giugale. “Furthermore, it will be important to more fully understand why those individuals who experienced new or worse urinary incontinence after their repair did not, at least during our 5-year follow-up period, seek treatment for their condition.”
Read more about the study and its findings using the reference below.
Learn more about Drs. Giugale and Zyczynski, and the Division of Urogynecology and Reconstructive Pelvic Surgery and the Women’s Center for Bladder and Pelvic Health at UPMC Magee.
Reference
Giugale L, Sridhar A, Ferrante KL, Komesu YM, Meyer I, Smith AL, Myers D, Visco AG, Paraiso MFR, Mazloomdoost D, Gantz M, Zyczynski H, for the NICHD Pelvic Floor Disorders Network. Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings. Female Pelvic Med Reconstr Surg. 2022; 28: 142-148.
