Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) coexist in up to 80 percent of women with pelvic floor dysfunction [1,2]. While these conditions are often concurrent, one may be mild or asymptomatic. Women without symptoms of SUI who undergo surgery for prolapse are at risk for postoperative urinary incontinence . SUI may also worsen after prolapse repair.
Deciding whether to perform a combined surgical procedure to treat both prolapse and SUI or a single procedure that addresses only one condition requires balancing the risk of incomplete treatment with the risk of exposing the patient to unnecessary surgery . This decision must be based on the best approach to address the patient's goals, rather than simply on anatomic correction [5,6].
Challenges in surgical decision-making in this clinical context include appropriate assessment of results of preoperative evaluation, some of which may be ambiguous (eg, prolapse noted on examination in a patient with no prolapse-related symptoms or a patient with advance prolapse with no leakage on prolapse reduction testing).
Combined surgical treatment for POP and SUI will be reviewed here. Other approaches to surgical and medical treatment of these conditions and other types of urinary incontinence are discussed separately. (See "An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women" and "Approach to women with urinary incontinence" and "Stress urinary incontinence in women: Choosing a primary surgical procedure".)
- Stress urinary incontinence (SUI) — Leakage of urine with increased intraabdominal pressure (eg, cough, laughter). (See "Approach to women with urinary incontinence", section on 'Classification'.)
- Occult SUI — SUI that is not symptomatic, but becomes apparent only during clinical or urodynamic urinary function testing when the prolapse is reduced (ie, stress testing with reduction of prolapsed structures). Occult stress incontinence is also referred to as latent, hidden, iatrogenic, or potential.
The definition of occult SUI is inconsistent in the medical literature. While some authors use the term to describe only incontinence which has been demonstrated on urinary function testing (as in this topic review), others use the term occult incontinence to signify that there is a possibility that SUI will occur after prolapse repair.
- De novo urinary incontinence — Urinary incontinence that is newly symptomatic, as an example, incontinence symptoms that develop after surgery in a previously continent patient. The type of new incontinence should be specified (eg, stress, urge). As an example, a patient with urgency incontinence and no SUI before surgery may have persistent urgency incontinence and de novo stress incontinence after surgery.
- Prolapse reduction testing — Elevation of prolapsed structures to approximate normal pelvic support during pelvic examination or clinical or urodynamic urinary function testing. This is performed in combination with a urinary stress test (cough test) to attempt to detect occult SUI. (See "Approach to women with urinary incontinence", section on 'Evaluation'.)