Presentation Authors: Kai Dallas*, Lisa Rogo-Gupta, Raveen Syan, Ekene Enemchukwu, Christopher Elliott, Stanford, CA
Introduction: Prophylactic sling placement may prevent de-novo stress urinary incontinence (SUI) in women undergoing pelvic organ prolapse (POP) surgery, however at the potential cost of overtreatment or sling complications. We aimed to compare future surgery rates in a population based cohort of women undergoing vaginal based POP surgery with and without a concomitant SUI procedure.
Methods: All women undergoing POP repair in California from 2005-2011 were identified from the Office of Statewide Health Planning and Development databases. Rates of repeat surgeries in those with and without concomitant SUI repairs were compared. Multivariate mixed effects logistic regression models were constructed to theoretically compare each patient's individualized risk of requiring a future SUI procedure if one was not performed at the time of POP repair, compared to a surgical complication if a prophylactic SUI procedure was performed up front.
Results: Of the 81,314 women studied, 38,456 underwent a concomitant SUI procedure and 42,858 did not. Those undergoing concomitant SUI surgery at the time of POP repair were more likely to undergo surgery for a complication than women undergoing future SUI surgery after foregoing an initial SUI repair (3.5% versus 3.0%, p < 0.001). Multivariate modeling revealed that most women undergoing POP repair would have a higher risk of requiring SUI revision surgery if a concomitant SUI operation was performed (60%) as compared to their risk of needing a future SUI surgery if a concomitant SUI procedure was eschewed (40%) (Figure 1). We developed a free interactive application where individual characteristics can be adjusted to allow a reader to explore which patient characteristics are at higher risk for failure with either strategy (https://stanfordfpmrs.shinyapps.io/app1/).
Conclusions: Women who undergo POP repair without concurrent SUI repair have a lower risk of future surgery compared to those who have POP and SUI repairs performed concomitantly. These results are contrary to the popular belief that prophylactic sling surgery at the time of a POP repair might decreases the risk of future surgery.
Source of Funding: The Valley Medical Foundation