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Pelvic organ prolapse and stress urinary incontinence in women: Combined surgical treatment

Charles W Nager, MD
Jasmine Tan-Kim, MD
Section Editor
Linda Brubaker, MD, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


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 [3]. 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 [4]. This decision must be based on the best approach to address the patient's goals, rather than simply on anatomic correction [5,6]. The rate of concurrent prolapse repair and continence procedures appears to be increasing. Data from the United States National Inpatient sample showed that for apical prolapse repair procedures, the rate of concurrent continence surgery increased from 38 percent in 2001 to 47 percent in 2009 [7].

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 "Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management" and "Evaluation of women with urinary incontinence" and "Surgical management of 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 "Evaluation of women with urinary incontinence", section on 'Clinical tests'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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