{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:10:47Z","timestamp":1791353447721,"version":"4.3.1"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,1,2]],"date-time":"2014-01-02T00:00:00Z","timestamp":1388620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,4]]},"abstract":"\n Objectives<\/jats:title>\n \n The combination of prolapse surgery with an incontinence procedure can reduce the incidence of stress urinary incontinence (\n SUI<\/jats:styled-content>\n ) after surgery, but may increase adverse events. We compared the effectiveness and safety of prolapse surgery versus combined prolapse and incontinence surgery in women with pelvic organ prolapse.\n <\/jats:p>\n <\/jats:sec>\n \n Design and setting<\/jats:title>\n \n Pubmed,\n EMBASE<\/jats:styled-content>\n ,\n DARE<\/jats:styled-content>\n , the Cochrane Library and the register of Current Controlled Trials were searched for randomised trials (restricted to Burch colposuspension and midurethral sling as incontinence procedure) from 1995 to 2013 limited to the English literature.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Two reviewers selected eligible articles and extracted the data. Pooling for\n SUI<\/jats:styled-content>\n was based on three patient groups: (1) women with coexisting\n SUI<\/jats:styled-content>\n ; (2) women asymptomatic for\n SUI<\/jats:styled-content>\n ; and (3) women with occult\n SUI<\/jats:styled-content>\n . For adverse events, pooling was based on incontinence procedure.\n <\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n \n The primary outcome was\n SUI<\/jats:styled-content>\n . The secondary outcomes were treatment for\n SUI<\/jats:styled-content>\n , bladder storage symptoms, obstructive voiding and adverse events.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seven trials were included. Pooling for women with coexisting\n SUI<\/jats:styled-content>\n was possible for objective\n SUI<\/jats:styled-content>\n with two studies and showed no difference. Statistical (\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a095%) and clinical heterogeneity was, however, high. The largest study showed a lower incidence of persisting\n SUI<\/jats:styled-content>\n (5% versus 23%) and treatment for this (0% versus 57%) in women who underwent prolapse repair with a midurethral sling. The second study did not find a difference in women undergoing a sacrocolpopexy with or without Burch colposuspension. In asymptomatic women, combination surgery resulted in a lower incidence of\n de\u00a0novo<\/jats:italic>\n subjective\n SUI<\/jats:styled-content>\n (two studies; 24% versus 41%; relative risk [\n RR<\/jats:styled-content>\n ], 0.6; 95% confidence interval [\n CI<\/jats:styled-content>\n ], 0.3\u20130.9;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a036%) and the need for subsequent anti\u2010incontinence surgery (three studies; 2% versus 7%;\n RR<\/jats:styled-content>\n , 0.4; 95%\n CI<\/jats:styled-content>\n , 0.2\u20130.8;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a013%). For the outcome objective\n SUI<\/jats:styled-content>\n , pooling was possible for five studies, but statistical heterogeneity was high (\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a082%) and the difference was not statistically significant. In the subgroup of women with occult stress incontinence, we found a lower incidence of objective\n SUI<\/jats:styled-content>\n after combination surgery (two studies; 22% versus 52%;\n RR<\/jats:styled-content>\n , 0.4; 95%\n CI<\/jats:styled-content>\n , 0.3\u20130.8;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a032%). There were no differences in bladder storage symptoms, urgency incontinence or long\u2010term obstructive voiding symptoms. Adverse events (two studies; 15% versus 10%;\n RR<\/jats:styled-content>\n , 1.6; 95%\n CI<\/jats:styled-content>\n , 1.0\u20132.5;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a00%) and prolonged catheterisation (three studies; 6% versus 1%;\n RR<\/jats:styled-content>\n , 4.5; 95%\n CI<\/jats:styled-content>\n , 1.5\u201313.3;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a00%) were more frequent after vaginal prolapse repair with a midurethral sling.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Combination surgery reduces the risk of postoperative stress incontinence, but short\u2010term voiding difficulties and adverse events were more frequent after combination surgery with a midurethral sling.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.12509","type":"journal-article","created":{"date-parts":[[2014,1,2]],"date-time":"2014-01-02T00:52:50Z","timestamp":1388623970000},"page":"537-547","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":111,"title":["Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta\u2010analysis of randomised trials"],"prefix":"10.1111","volume":"121","author":[{"given":"JM","family":"van der Ploeg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Martini Hospital Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"van der Steen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Deventer Hospital Deventer The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Oude Rengerink","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CH","family":"van der Vaart","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Reproductive Medicine University Medical Centre Utrecht Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JP","family":"Roovers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam The 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