Urinary incontinence and genital prolapse

Prolapse commonly coexists with lower urinary tract dysfunction. If symptomatic stress urinary incontinence is often described by patients with low stage pelvic organ prolapse, obstructive symptoms are common in patients with stage 3 or 4 prolapse. Positive preoperative reduction testing in stress continent women planning prolapse repair is associated with a higher risk for postoperative leakage and clearly identify a high risk population. To date it has not been proven that urodynamic testing may provide more precise data than physical examination to advocate an additional stress urinary surgery at the time of prolapse repair. A systematic prophylactic Burch colposuspension significantly reduces the risk of postoperative SUI. In patients with occult SUI, a concomitant TVT at the time of vaginal prolapse surgery significantly reduces the risk of postoperative SUI. In patients without leakage during reduction testing, there is no evidence for performing a concurrent TVT. (C) 2009 Elsevier Masson SAS. Tous droits reserves.