A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair

At 3 months, prophylactic midurethral sling placement during vaginal prolapse surgery significantly reduced the rate of urinary incontinence or treatment for incontinence compared to sham incisions (2

Effect: improvement; 23.6% vs 49.4%; adjusted OR 0.31; CI: 95% CI 0.19 to 0.50

At 12 months, prophylactic midurethral sling placement during vaginal prolapse surgery resulted in a lower rate of urinary incontinence compared to sham incisions (27.3% vs 43.0%, adjusted OR 0.48, 95

Effect: improvement; 27.3% vs 43.0%; adjusted OR 0.48; CI: 95% CI 0.30 to 0.77

At 3 months, the sling group had significantly greater improvement in urinary symptoms (PFDI including UDI stress subscale and Incontinence Severity Index) than the sham group, but at 12 months only t

Effect: improvement; Greater improvement in UDI stress subscale and ISI in sling group at 3 and 12 months

The midurethral sling was associated with significantly higher rates of bladder perforation (6.7% vs 0%), urinary tract infection (31.0% vs 18.3%), major bleeding complications (3.1% vs 0%), and incom

Effect: adverse; Bladder perforation 6.7% vs 0%; UTI 31.0% vs 18.3%; major bleeding 3.1% vs 0%; incomplete emptying 3.7% vs 0%

Among women with a positive preoperative prolapse-reduction stress test, the sling appeared to provide greater benefit at 3 months (29.6% vs 71.9% incontinence, adjusted OR 0.13, 95% CI 0.05 to 0.34)

Effect: improvement; Positive stress test: 29.6% sling vs 71.9% sham, adjusted OR 0.13; CI: 95% CI 0.05 to 0.34