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Management of Occult Urinary Incontinence with Prolapse Surgery

  • Joshua A. CohnEmail author
  • Ariana L. Smith
Female Urology (L Cox, Section Editor)
  • 80 Downloads
Part of the following topical collections:
  1. Topical Collection on Female Urology

Abstract

Purpose of Review

The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies.

Recent Findings

Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP.

Summary

A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.

Keywords

Pelvic organ prolapse Stress urinary incontinence Midurethral sling Cystocele 

Notes

Compliance with Ethical Standards

Conflict of Interest

Joshua A. Cohn and Ariana L. Smith each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyEinstein Healthcare NetworkPhiladelphiaUSA
  2. 2.Fox Chase Cancer CenterPhiladelphiaUSA
  3. 3.University of Pennsylvania Health System and Perelman School of MedicinePhiladelphiaUSA

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