The Use of a Vaginal Pessary to Decide Whether a Midurethral Sling Should be Added to Prolapse Surgery.
Women with pelvic organ prolapse (POP) are at risk of developing stress urinary incontinence (SUI) following prolapse surgery. Combining POP repair with anti-incontinence surgery reduces the incontinence rate but leads to overtreatment. Performing POP repair only, leads to undertreatment. Is a vaginal ring pessary a useful tool in deciding whether a midurethral sling (MUS) should be added to prolapse surgery?Retrospective cohort study of women with symptomatic POP, but without bothersome SUI, who underwent vaginal prolapse repair between 01/01/2008 and 31/12/2017. Preoperatively all women had a pessary inserted to detect occult SUI. If the pessary revealed bothersome SUI, a concomitant MUS was proposed. The primary outcome at follow-up was ‘de novo’ SUI.Two hundred twenty women were included. After pessary insertion 132 (60%) women remained continent, 20 (9%) reported non-bothersome SUI and 68 (31%) had bothersome SUI. The latter were offered combined surgery. At follow-up, bothersome SUI was present in 12 (12/132, 9%) women that had been continent preoperatively and in seven (7/20, 35%) that had had non-bothersome SUI. In women who were continent with the pessary (n=132) eleven MUS procedures would have been needed to prevent one case of postoperative SUI (number needed to treat (NNT)=11). In women who had non-bothersome SUI (n=20), only three MUS procedures would have been necessary (NNT=3).In women with symptomatic POP, a pessary is a useful tool in deciding whether or not to add a MUS.