Incontinence after colposuspension during sacropexy: preliminary results of a randomised study

INTRODUCTION & OBJECTIVES: This study evaluates the impact of colposuspension during sacropexy for severe urogenital prolapse in preoperatively continent and incontinent women. MATERIAL & METHODS: 92 patients with severe urogenital prolapse were prospectively divided in 2 groups on the basis of preoperative subjective and/or objective evaluation of incontinence: Group A included 66 continent patients and Group B 26 incontinent. All 92 underwent sacropexy but each group was randomly assigned to colposuspension. The urogynaecological work-up included clinical assessment (using the Halfway system to classify prolapse and the Ingelman Sundberg for incontinence), the Urogenital Distress Inventory (UDI) and Impact Incontinence Quality of life (IIQ) questionnaires, urological and gynaecological ultrasound scans, a complete urodynamic test which included the urethral pressure profi le and Valsalva leak point pressure (VLPP) with reduced prolapse. Methods and terms complied with International Continence Society Standards. Check-ups were scheduled for 3, 6 and 12 months after surgery and then yearly. Mean follow-up is 38 months (range 12-90). RESULTS: The mean age was 60 ± 9.6 S.D. (range 27-75 years) with a median parity of 2. All patients presented with grade 3 or 4 prolapse. 34/66 patients in Group A and 14/26 in group B underwent colposuspension. In group A post-operative incontinence was present in 12/34 patients who had undergone colposuspension: 7 Grade (G) 1 (1 urge and 6 stress incontinence); 4 G2 (2 mixed, 2 stress), 1 G3 stress incontinence; and in 3 (2 G1: 1 stress and 1 mixed incontinence; 1 G3 mixed incontinence) of the 32 patients who had not. The frequency of post-operative incontinence was signifi cantly greater in patients who had undergone colposuspension (p<0.05). No intra-group differences emerged in patient satisfaction. In Group B incontinence persisted in 6/14 who underwent colposuspension (3 G1: 2 stress and 1 mixed incontinence; 2 G2: 1 urge and 1 stress; and 1 G3 stress incontinence) and in 3/12 who did not (2 G 1: 1 stress and 1 mixed incontinence; 1 G 3 stress incontinence). The difference is not signifi cant (p>0.05) probably due to low patient numbers to date. Hypermobility does not modify the results in either groups. CONCLUSIONS: As incontinence persisted in 42% of incontinent patients and developed ex novo in 35% of continent patients, the colposuspension technique requires careful assessment when it is combined with sacropexy, especially when it is performed as prophylaxis for postoperative incontinence.