A sling operation performed during vaginal prolapse surgery reduces the chances of post-operative urinary incontinence; however, it is associated with serious adverse effects.
Prolapse is a condition where an organ falls out of its original location in the body. It commonly affects women in whom organs like the uterus, bladder, or the vaginal wall move downwards through the vagina or the rectum. People who suffer from prolapse undergo an operation to replace the organ into the normal position. However, one complication of such an operation is loss of urine retaining ability thereby resulting in urinary incontinence, which could affect the social life of the individual.
Researchers carried out a study to evaluate if an additional surgery to add support to the urethra could reduce the chances of urinary incontinence following prolapse surgery. The study included women who did not suffer from prior urinary incontinence and were due to undergo vaginal prolapse surgery.
Some of the women in the study received a retropubic midurethral sling during the operation to repair the vaginal prolapse. A sling operation is a procedure where a sling is placed under the urethra to support it and prevent urinary incontinence in conditions of increased intra-abdominal pressure like while laughing, sneezing or during physical activity. The women were assessed at 3, 6 and 12 months following the surgery. A total of 337 women completed the follow-up at 1 year.
Three months following surgery, the incidence of urinary incontinence was nearly half in the group that received the sling operation as compared to those who did not receive the urethral support (23.6% vs 49.4%). This benefit persisted even twelve months following the operation (27.3% vs. 43.0%).
However, the rate of complications was significantly more in the group that underwent the sling operation and included bladder perforation (6.7% vs. 0%), urinary tract infection (31.0% vs. 18.3%), bleeding complications (3.1% vs. 0%), and incomplete bladder emptying (3.7% vs. 0%) in the first 6 weeks after surgery.
The study thus reiterates the advantages of urethral support operations during vaginal prolapse surgery. However, the benefits of the surgery must be weighed against the possibility of serious adverse effects, and the decision should be individualized for each patient.
1. A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair; John T Wei et al; N Engl J Med 2012; 366:2358-2367