A multicenter study involving a UT Southwestern Medical Center urogynecologist will eliminate some of the guesswork physicians face about whether to use a sling during vaginal prolapse repair to prevent urinary incontinence.
The clinical investigation from eight medical centers across the U.S. provides the first surgical outcome evidence on the benefits and risks of midurethral slings for women with vaginal prolapse who show no symptoms of urinary incontinence before surgery.
One in five women will undergo surgery for pelvic organ prolapse, a condition that often causes involuntary loss of urine. Vaginal prolapse can mask urinary incontinence, however, which is why many women do not experience the condition before having surgery.
"This study provides very good data from a blinded, randomized trial that can be used to counsel patients who are undergoing a vaginal repair for prolapse who don't have stress incontinence symptoms," said Dr. Joseph Schaffer, professor of obstetrics and gynecology and a co-author of the study, which appears in the June 21 issue of The New England Journal of Medicine.
Slings made out of surgical mesh to support the urethra are the "gold standard" in vaginal prolapse repair surgery to prevent urinary incontinence, Dr. Schaffer said. But complications of sling placement over time can include decreased bladder emptying and voiding dysfunction, or the inability to empty the bladder normally.
Not every woman who has a sling placed will ultimately need it. Dr. Schaffer said this study, which is part of the collaborative Pelvic Floor Disorders Network, provides solid numbers to the risk outcome of sling placement. It will help physicians counsel women who don't have incontinence before surgery but who want to avoid bothersome postoperative symptoms of the condition.