Preventing incontinence after prolapse surgery — Women with advanced pelvic organ prolapse (POP) often develop stress urinary incontinence following POP repair. A randomized trial found that for women with stage II to IV POP who were continent before surgery, a prophylactic retropubic midurethral sling at the time of transvaginal prolapse repair significantly reduced the rate of postoperative urinary incontinence 12 months after surgery (27 versus 43 percent) [34]. However, women in the sling group had significantly higher rates of some perioperative complications, including bladder perforation, incomplete bladder emptying, and urinary tract infection. Based upon these data, the decision regarding performing prophylactic continence procedure at the time of transvaginal POP repair requires thorough counseling of the patient regarding risks and benefits. (See "Pelvic organ prolapse and stress urinary incontinence in women: Combined surgical treatment", section on 'POP with no symptoms of SUI'.)

Pretreatment urodynamic testing — For women with uncomplicated stress urinary incontinence (SUI), it appears that pretreatment urodynamic testing does not improve treatment outcomes. In a randomized trial, the rate of successful treatment at one year was found to be non-inferior for women who underwent pretreatment urodynamic testing compared with office evaluation (both were 77 percent) [35]. (See "Stress urinary incontinence in women: Preoperative evaluation for a primary procedure", section on 'Women with uncomplicated SUI'.)

1.                               34.Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 2012; 366:2358.

2.                               35.Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 2012; 366:1987.