Prophylactic Midurethral Slings at the Time of Pelvic Organ Prolapse Repair.

Abstract

Importance: Prophylactic midurethral sling (MUS) placement can prevent de novo stress urinary incontinence (SUI) after pelvic organ prolapse (POP) repair, but the concern about additional MUS-related adverse events remains.

Objective: The objective of this study was to compare postoperative outcomes between women with and without preoperative SUI after undergoing concomitant POP repair and MUS placement.

Study design: This retrospective cohort study included women undergoing POP repair with concurrent MUS placement between 2017 and 2023. Patients in the prophylactic group did not have preoperative SUI, whereas those in the nonprophylactic group did. The primary outcome was postoperative SUI. Secondary outcomes included recurrent urinary tract infection (UTI), voiding difficulty, overactive bladder symptoms, pelvic pain, and mesh complications. Multivariate logistic regression was used to adjust for potential confounders.

Results: Of 1,132 women, there were 409 (36.1%) prophylactic and 723 (63.9%) nonprophylactic MUS procedures. Women in the prophylactic group were significantly older, predominantly postmenopausal, of lower body mass index, and more commonly had stage 3 POP and underwent sacrocolpopexy. Median follow-up was 12 months. Postoperative SUI occurred less frequently in the prophylactic group (1.7% vs 5.8%; P=0.001). Women with a prophylactic MUS were nearly 3 times less likely to have postoperative SUI (adjusted odds ratio, 0.31; 95% CI, 0.14-0.72). Postoperative recurrent UTIs were less common in the prophylactic group (1.5% vs 4.4%; P=0.008), whereas other adverse events were comparable between groups.

Conclusions: Women without preoperative SUI had lower rates of postoperative SUI after concomitant POP repair and MUS placement, with similar rates of adverse events.