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
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.
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