Obstet Gynecol Sci.  2014 Jan;57(1):50-58.

Comparison of midurethral sling outcomes with and without concomitant prolapse repair

• Han EJ
• Kim SR
• Kim SK
• Bai SW

Abstract

OBJECTIVE
We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair.
METHODS
We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis.
RESULTS
We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970).
CONCLUSION
The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

Keyword

Midurethral slings; Pelvic organ prolapse; Urodynamics

MeSH Terms

Animals
Female
Humans
Logistic Models
Medical Records
Mice
Odds Ratio
Pelvic Organ Prolapse
Prolapse*
Surveys and Questionnaires
Retrospective Studies
Suburethral Slings*
Urinary Bladder
Urodynamics

Figure

• 

  Fig. 1 Preoperative pelvic organ prolapsed (POP)-Q staging of the midurethral sling with concomitant repair group. a)POP-Q stage. 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm, and point C is between the total vaginal length (TVL) and TVL -2 cm. I: The most distal portion of the prolapse is >1 cm above the level of the hymen. II: The most distal portion of the prolapse is <1 cm proximal or distal to the plane of the hymen. III: The most distal portion of the prolapse is <1 cm below the plane of the hymen but no further than 2 cm less than the TVL. IV: Complete to nearly complete eversion of the vagina. The most distal portion of the prolapsed protrudes to more than (TVL-2) cm. Aa: Anterior wall 3 cm from the hymen, -3 cm to +3 cm. Ba: Most part of the rest of the anterior wall, -3 cm to +TVL. C: Cervix or vaginal cuff ±TVL. D: Posterior fornix (if no prior total hysterectomy) ±TVL. Ap: Posterior wall 3cm from the hymen, -3 cm to +3 cm. Bp: Most part of the rest of the posterior wall, -3 cm to +TVL.

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