By Christopher Walsh
A midurethral sling device added during surgery for vaginal prolapse repair reduces the risk for postoperative urinary incontinence, research shows.
Caution should be advised, however, because the likelihood for expected adverse events is higher in women receiving the sling than in those receiving superficial incisions.
Commenting on the results in a press statement, study co-author Kimberly Kenton (Loyola University Health System, Maywood, Illinois, USA) cautioned that although slings are a valuable option for certain women: "we should avoid using them with all patients undergoing a procedure for pelvic-organ prolapse."
Although the rates of serious or unexpected adverse events were similar between the groups by the end of the trial, patients receiving the sling were significantly more likely to develop various expected adverse events, such as bladder perforation, urinary tract infection, major bleeding complications, and incomplete bladder emptying in the first 6 weeks after surgery.
At both 3 and 12 months follow up, the rate of urinary incontinence (or treatment for urinary incontinence) in the sling group was significantly lower than it was in the sham group, at 23.6% versus 49.4%, and 27.3% versus 43.0%, respectively.
At 12 months, the number needed to treat with the sling to prevent one case of urinary incontinence was 6.3.
Pelvic-organ prolapse occurs when the supporting tissues in and around the vagina weaken to the point at which organs fall from their normal position and bulge into the vaginal wall, sometimes even protruding from the vaginal opening.
It is a common condition, particularly after childbirth, and around one in five women will undergo vaginal prolapse surgery during their lifetime.
The Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) study, a multicenter, randomized, single-blind trial, published in TheNew England Journal of Medicine, involved women who received vaginal prolapse repair and had no symptoms of stress urinary incontinence prior to surgery.
Accompanying their surgery, patients were randomly allocated to receive treatment with either a midurethral sling (Gynecare TVT, Ethicon, Somerville, New Jersey, USA) or superficial, sham incisions that mimicked the outward appearance of the sling incisions.
To ensure that patients are aware of the benefits and risks of the procedure, Kenton reinforced the importance of counseling before surgery, adding that "one approach might be to only treat patients who develop incontinence after surgery."
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