Treatment of concomitant prolapse and stress urinary incontinence via a transobturator subvesical mesh without independent suburethral tape.

Sergent, Fabrice; Sentilhes, Loïc; Resch, Benoît; Verspyck, Eric; Medeiros, Richard; Descamps, Philippe; Marpeau, Loïc

OBJECTIVE Evaluate the efficacy of a transobturator subvesical mesh for cystocele in concomitant stress urinary incontinence (SUI). DESIGN Longitudinal observational study. SETTING Tertiary referral urogynecology center. POPULATION One hundred and five women with at least an anterior vaginal wall prolapse and concomitant SUI who underwent surgery. METHODS After reduction of prolapse elements, the intervention consisted of a non-absorbable monoprosthesis placement with two transobturator expansions and, if necessary, associated hysterectomy or infraccocygeal sacropexy. No specific procedure was performed for SUI. MAIN OUTCOME MEASURES All patients had a physical examination and a subjective symptoms assessment via questionnaire in the preoperative period and at one-year or more after surgery. The pelvic organ prolapse quantification system was used for anatomical results. For SUI, Ingelman-Sundberg classification and cough test were used. Loss of urine was measured by a one-hour pad test. Functional results were evaluated by visual analog scale, quality-of-life questionnaires, including the pelvic floor distress inventory and the pelvic floor impact questionnaire. RESULTS Median follow-up was 45 months (range: 12-72). A total of 102 women (97%) were cured of their prolapse, of whom 72 (69%) were cured of their SUI and 13 (12%) showed improvement. Pad test, visual analogic scale and quality-of-life questionnaires were all improved (p < 0.05). Complications consisted of one rectal injury, one transitory urinary retention, and two hematomas. Of the erosions 6% was observed for monofilament polypropylene prostheses. CONCLUSION Transvaginal monoprosthesis for the simultaneous correction of prolapse and SUI represents an effective treatment for bulky or recurrent prolapse as well as posthysterectomy vaginal vault prolapse.