Comparison between mid-urethral sling (MUS) concurrent with pelvic reconstructive surgery (PRS) and MUS after PRS in treating stress urinary incontinence

To assess the outcomes of patients with symptomatic POP and SUI who underwent a combined surgery and those with SUI repair after prior extensive PRS surgery. A comparative retrospective analysis of patients with symptomatic advanced POP, done in a tertiary referral facility. The cohort was divided into two groups: patients who received both PRS and MUS at the same time, and patients who received extensive PRS first, followed by secondary MUS, based on postoperative observations. A total of 478 patients included in the combined-surgery group and 82 were included in the two-steps group. TVM surgeries types were Perigee, Avaulta, PROLIFT, Elevate A, Uphold, Surelift, and Calistar-S. MUS procedures included Gynecare TVT, Monarc, Obtryx, KIM Miniarc, Ophira, Ajust, and Solyx. The primary endpoint was objective and subjective cure rates after one-year. Secondary outcomes included quality of life, LUTS, and surgical complications. The objective cure rate in the combined group was 90%, whereas the subjective cure rate was 89.1%. The objective and subjective cure rates in the staged group were lower: 81.7% and 79.3%, respectively. Patients in the Staged group were younger and had higher BMI. In addition, they had a higher degree of SUI, a larger rate of ISD, a higher Pad test, and worse urodynamic exam results. This study shows that combined surgery for treatment of POP and SUI is more efficient than staged one, in 12-months follow-up period. Furthermore, patients with occult SUI had better outcome than those with overt SUI.