What happens to urinary incontinence after pelvic organ
Received: 20 February 2018 /Accepted: 24 May 2018
The International Urogynecological Association 2018
Introduction and hypothesis The beneficial effect of pelvic organ prolapse (POP) surgery on urge urinary incontinence (UI) is
well described in the literature, while effect on preoperative stress UI (SUI) is still unclear. The aim of this study was to investigate
changes concerning UUI following POP surgery without concomitant anti-incontinence procedures and to identify possible
factors influencing the changes.
Methods We conducted a retrospective study of 678 women with prolapse surgery using native tissue repair during a 3-year
period. Patients completed three prolapse questions from the International Consultation on Incontinence–Vaginal Symptoms
(ICIQ-VS) questionnaire and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form
(ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who scored >0 on the ICIQ-UI SF before surgery
were included in the study.
Results A total of 379 patients (55.9%) with POP had concomitant UI. At 3 months’ follow-up, 174 patients (46%) became
continent compared with 205 patients (54%) with UI. Patients with remaining UI had statistically significant higher mean
preoperative ICIQ-UI SF score than patients who became dry. The risk of remaining UI after POP surgery was greater in patients
with previous anti-incontinence repair. UI type was not a risk factor for its persistance.
Conclusion Almost half of the patients with UI before POP surgery became completely dry after prolapse surgery alone. Severity
of incontinence and previous anti-incontinence surgery were identified as risk factors for persisting UI after POP surgery. We
found a reduction of incontinence after an operation in any of the three compartments.
Keywords Pelvic organ prolapse
Pelvic organ prolapse (POP) is estimated to effect up to 50%
of women ≥50 years . Urinary incontinence (UI) is an even
more prevalent condition in women , and the two condi-
tions often coexist. The relationship is complex and many
factors are still unknown . Preoperative concomitant stress
UI (SUI) is reported in 40–62.7% of patients with POP [4, 5],
while overactive bladder (OAB) symptoms characterized by
urgency, frequency, and urge urinary incontinence (UUI) oc-
cur in 55–86% of patients with vaginal prolapse [6–9].
Numerous previous studies report on the beneficial effect of
POP repair on symptoms of OAB [4, 6, 10–15].
Concomitant anti-incontinence surgery at the time of
prolapse repair remains controversial. Some studies have
women undergoing POP repair [16, 17]. Other studies
suggest a one-step procedure (combined prolapse and in-
continence surgery) in women with SUI or occult SUI
diagnosed preoperatively [16, 18–20]. At the same time,
a significant proportion of the literature supports a two-
step procedure or a delayed approach to avoid unnecessary
surgery in a proportion of patients [21–23]. The argument
is that anti-incontinence surgery could be an unnecessary
intervention in almost one third of patients who could be
cured after prolapse surgery alone .
Conference Presentations This work has been presented at the Danish
Urogynaecological Society annual meeting in Fredericia, Danmark, in
* Aiste Ugianskiene
Department of Obstetrics and Gynecology, Aalborg University
Hospital (AAUH), Reberbansgade 15, 9000 Aalborg, Denmark
International Urogynecology Journal