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Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review

Authors Wu Y, Welk B

Received 5 March 2019

Accepted for publication 20 May 2019

Published 19 June 2019 Volume 2019:11 Pages 179—188

DOI https://doi.org/10.2147/RRU.S191555

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Jan Colli


You (Maria) Wu,1 Blayne Welk2

1Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada; 2Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada

Abstract: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Site-specific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.

Keywords: stress urinary incontinence, pelvic organ prolapse, midurethral sling, transvaginal mesh, apical suspension, native tissue repair

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