Surgical correction of pelvic organ prolapse and de novo stress urinary incontinence (literature review)

Abstract

Pelvic organ prolapse (POP) is one of the most common manifestations of pelvic floor dysfunction. Clinically significant forms of the condition lead to numerous pelvic organ dysfunctions. The primary strategy for POP is surgical treatment aimed at restoring the normal alignment of the pelvic organs. At the same time, the primary goal of surgical correction is to eliminate the dysfunction and improve the patient's quality of life. This is an extremely challenging issue. Literature data show that 8-55% of patients experience persistent or de novo stress urinary incontinence (SUI) after surgery. The aim of this review is to highlight current understanding of the epidemiology, risk factors, and clinical approaches to preventing de novo SUI after surgical treatment of POP. Currently, known risk factors include patient age and menopausal status, high body mass index and visceral incontinence, severe anterior vaginal wall prolapse, chronic obstructive pulmonary disease, diabetes, previous hysterectomy, advanced maternal age at first pregnancy, and parity ≥3. The most significant risk factors are preoperative urinary incontinence and occult urinary incontinence. This review provides a detailed description of diagnostic methods for occult urinary incontinence and notes the potential for this condition overdiagnosis. Despite the obvious relevance of the problem of de novo SUI after surgical treatment of POP, and the presence of known risk factors for its development and diagnostic methods, the clinical approaches to the management of such patients remain unclear. The choice between immediate suburethral sling placement and a staged approach to correcting pelvic organ prolapse in women with concomitant SUI remains a matter of debate. A single-stage procedure reduces the incidence of postoperative SUI but increases the risk of complications, while a staged approach avoids unnecessary interventions in a significant number of patients. But it requires dynamic observation and possible subsequent treatment. The decision on surgical treatment tactics should be made individually, considering risk factors, the clinical signs, and the patient's preferences.