Sling May Lower Incontinence Risk After Prolapse Surgery

Placement of a midurethral sling during vaginal surgery for pelvic-organ prolapse decreases the likelihood of postoperative urinary incontinence, but it also is associated with higher rates of adverse events, a study found.

Investigators randomly assigned 337 women undergoing surgery for anterior prolapse to receive a either a midurethral sling (165 patients) or sham incisions (172 patients) during surgery. The women did not have symptoms stress urinary incontinence preoperatively.

At 12 months, 27.3% of the sling recipients had urinary incontinence compared with 43% of patients in the sham group, a difference that translated into a significant 52% decreased risk of urinary incontinence after adjusting for potential confounders, in the New England Journal of Medicine (2012;366:2358-2367).

During follow-up, 12 women in the sling group (7.3%) underwent subsequent treatment for urinary incontinence compared with 19 (11%) in the sham group.

The researchers, led by John T. Wei, MD, of the University of Michigan in Ann Arbor, calculated that 6.3 patients would need to be treated with a sling to prevent on case of urinary incontinence at 12 months. Sling recipients had significantly higher rate of bladder perforation and urinary tract infection than the sham group (6.7% vs. 0% and 31% vs. 18.3%, respectively). Sling recipients also had significantly higher rates of major bleeding complications (3.7% vs. 0%) and incomplete bladder emptying six weeks postoperatively (3.7% vs. 0%).

“Counseling of women who are planning to undergo vaginal-prolapse surgery should include attention to both the benefits and the risks of sling placement,” Dr. Wei's group concluded.

Regarding study limitations, they noted that it is possible that the incidence of postoperative incontinence may differ according to the type of anterior repair or apical suspension, “but our study was not powered to assess these subgroups.”

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