Performing an anti-incontinence procedure at the time of prolapse repair :: Prolapse and stress urinary incontinence

Both can occur concurrently. Women with prolapse who are continent have an increased risk of developing de novo SUI after surgical prolapse repair. Therefore, addressing SUI at the time of surgical intervention for prolapse is an important consideration for improving the quality of life and decreasing pelvic floor symptoms. Performing an anti-incontinence procedure at the time of prolapse repair is effective in reducing the risk of occult SUI postoperatively.

TVTs and Mesh procedures for SUI repairs

Urodynamic Stress Incontinence is the leakage/ dribbling of urine through the urethra in the absence of Detrussor muscle instability. Genuine form of Stress Incontinence in due to increased abdominal pressure. This condition can be further complicated by presence of co-existing conditions such as detrusor muscle over activity(OAB) , intrinsic sphincter deficiency, or pelvic organ prolapse.Globally about 10% middle-aged women undergo the symptoms.Treatment and ruling out of concomitant intrinsic sphincter deficiency and detrusor muscle instability is absolutely important before surgical management of SUI is started.

A)      Sling therapy is the enhanced surgical support of the urethra, routinely performed by vaginal or abdominal (open or laparoscopic) routes, or, most recently, by access to the obturator foramen. Gynecare TVT was the first of a generation of retropubic slings that could be passed upwards vaginally; it was followed by the SPARC Sling system, which could be passed through supra-pubic incisions downward. This provided 84% cure and success rate for patients that were primarily incontinent. But the surgery carried a 7% rate of bladder perforations and demanded a subsequent cystoscopy.

The next generation of slings placed a similar device under the urethra, but now exited much more laterally through the medial obturator foramen in the top of the leg.