Specific features of the treatment of stress urinary incontinence in patients with III-IV stage of anterior vaginal prolapse

Aim: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. Materials and methods: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. Results: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didn’t affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. Discussion: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. Conclusion: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.

genital prolapse, stress urinary incontinence, extraperitoneal anterior colpopexy, urethral sphincter insufficiency