Objective: The goal of this study was to compare the rates of stress urinary incontinence (SUI) in women who underwent robotic sacrocolpopexy (RSCP) with and or without a concomitant midurethral sling. Design: This was a retrospective multicenter cohort study. Materials and Methods: Women who underwent RSCP between November 2007 and January 2010 were placed into two groups: patients who had a concomitant sling with their surgery and those who had had robotic sacrocolpopexy alone. The decision to place a sling was based on the presence of a preoperative urodynamic stress incontinence or a positive result of a supine cough stress test. Outcome Measures: Outcomes were measured using validated condition-specific questionnaires. The primary outcome was any reported SUI at 3–6 months after surgery. Results: A total of 82 women were included in the study. The overall rate of postoperative SUI was 31.7%. Postoperative SUI was lower in patients who underwent RSCP with a concomitant sling, compared with those who underwent RSCP alone (18.6% versus 46.2%; relative risk: 0.4; 95% confidence interval: 0.2–0.8, p=0.007). The number of slings needed to prevent 1 case of postoperative SUI was 3.6. Conclusions: Women who underwent RSCP alone reported a high rate of de novo SUI. Concomitant sling placement significantly reduced this risk. (J GYNECOL SURG 18:5)
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References
1.
MaherC, BaesslerK, GlazenerCM, AdamsEJ, HagenS. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev, 2010; 4:CD004014.
2.
SmithFJ, HolmanCD, MoorinRE, TsokosN. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol, 2010; 116:1096.
3.
OlsenAL, SmithVJ, BergstromJO, CollingJC, ClarkCL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol, 1997; 89:501.
4.
BrubakerL, CundiffGW, FineP, NygaardIet al.Pelvic Floor Disorders Network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med, 2006; 354:1557.
5.
BrubakerL, NygaardI, RichterHE, ViscoAet al.Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol, 2008; 112:49.
6.
ElserDM, MoenMD, StanfordEJ, KeilK. Urogynecology Network. Abdominal sacrocolpopexy and urinary incontinence: Surgical planning based on urodynamics. Am J Obstet Gynecol, 2010; 202:375.e1.
7.
GellerEJ, SiddiquiNY, WuJM, ViscoAG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol, 2008; 112:1201.
8.
MisraiV, RoupretM, CourF, Chartier-KastlerE, RichardF. De novo urinary stress incontinence after laparoscopic sacral colpopexy. BJU Int, 2008; 101:594.
9.
ViscoAG, BrubakerL, NygaardI, RichterHE, CundiffGet al.Pelvic Floor Disorders Network. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: The colpopexy and urinary reduction efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct, 2008; 19:607.
