A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair

Women undergoing surgery for vaginal prolapse are at risk for urinary incontinence. In this randomized trial, women who received a midurethral sling had lower rates of incontinence at 3 and 12 months but higher rates of adverse events than those who received sham incisions. One in five women will undergo surgery for pelvic-organ prolapse in her lifetime, 1 and urinary incontinence commonly occurs with pelvic-organ prolapse. In previously continent women with pelvic-organ prolapse, urinary incontinence develops in approximately a quarter of them after prolapse repair; this phenomenon is referred to as occult, latent, de novo, iatrogenic, or potential stress urinary incontinence. 2 In 2006, the Colpopexy and Urinary Reduction Efforts (CARE) trial 2 showed that adding a bladder-neck suspension at the time of abdominal prolapse surgery in women without preoperative stress incontinence significantly reduced the risk of postoperative stress urinary incontinence (23.8%, vs. 44.1% in the control . . .