The impact of pelvic organ prolapse surgery on bladder function: comparison of three surgical approaches
IUGA Academy. Padoa A. Jun 30, 2018; 212899; 379 Topic: Pelvic Organ Prolapse
Dr. Anna Padoa
Dr. Anna Padoa

Access to Premium content is currently a membership benefit.

Click here to join IUGA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)


The impact of pelvic organ prolapse surgery on bladder function: comparison of three surgical approaches

Padoa, A1; Tsviban, A1; Hassouna, H1; Smorgick, N1

1: Yitzhak Shamir Medical Center

Introduction: Epidemiological studies suggest overactive bladder (OAB) is more common in pelvic organ prolapse (POP) patients, with a relative risk of 2.1-5.8. Stress urinary incontinence (SUI) is found in up to 55 % of women with POP. To date, few studies have addressed the impact of different POP repair approaches on lower urinary tract symptoms (LUTS).

Objective: This longitudinal cohort study compares the impact of surgery for advanced prolapse on LUTS. Surgical approaches included: Sacrospinous fixation (SSF) and colporrhaphy (group 1), single-incision mesh repair with Elevateä (group 2) and robotic sacrocolpopexy (group 3). The primary outcome was the incidence of urgency urinary incontinence (UUI) and SUI 6-18 months after surgery. The secondary outcome was the predictive value of urodynamics for post-operative urinary urgency.

Methods: Between November 2012 and July 2017, patients eligible for POP surgery for stage 3 and 4 prolapse were recruited. Pre-operative evaluation included a symptom questionnaire, POP-Q and the PFDI-20 questionnaire. Conventional urodynamic studies were done in patients with LUTS. Vaginal procedures were performed by a single surgeon. Right sacrospinous fixation was done using either Capioä or DigitexÒ. Elevateä was performed following manufacturer instructions. Robotic sacrocolpopexy was carried out by a team including a urogynecologist and an endoscopic surgeon. Post-operative follow-up was scheduled at 6-18 months.

Results: 165 patients were recruited. Patients who returned for follow-up at 6-18 months were included in data analysis: 62 patients in group 1, 31 patients in the group 2 and 31 patients in the group 3. Patients in group 3 were younger and had lower parity. POP-Q measurements were higher in group 2 and 3. A vaginal hysterectomy vas carried out in 85.5% of group 1 and in 77.4% of group 2. A supracervical hysterectomy was performed in 71% of group 3. Rates for concomitant TVT were similar between groups (group 1: 56%, group 2: 58% and group 3: 54.8%). The outcome of surgery on LUTS was assessed at 12 months (range: 6-18 months, mean= 11.8 months). Subjective outcome regarding bladder function was assessed through PFDI-20: a positive reply to question 16 was considered positive for UUI and a positive reply to question 17 for SUI. At follow-up, patients in group 3 had less UUI than patients in group 1 and 2: 22.6% in group 1, 12.9% in group 2 and 3.2% in group 3 (p=0.046). De-novo SUI was more common in group 2: 16.1%, as compared to 1.6% in group 1 and 0% in group 3 (p=0.003). Of the 74 patients with pre-operative urinary urgency, urgency was present in 28.6% of patients without pre-operative DO and in 52.2% of patients with pre-operative DO (p=0.039).

Conclusions: Sacrocolpopexy may involve a lower risk of post-operative UUI than vaginal surgery. Vaginal mesh surgery is related to a higher risk of de novo SUI. Pre-operative DO is a risk factor for post-operative urinary urgency.


Curr Opin Obstet Gynecol. 2010 Oct;22(5):399-403.

Int Urogynecol J. 2013 Nov;24(11):1843-52.


Work supported by industry: no.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings