Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing

Introduction and hypothesis: The objectives of this study were to evaluate the incidence of postoperative stress uri- nary incontinence (SUI) after laparoscopic sacrocolpopexy (LSCP) in women with negative preoperative prolapse re- duction stress testing (PPRST) and to identify associated risk factors.
Methods: This was a retrospective cohort study comprising women who consecutively underwent double-mesh LSCP without concomitant SUI surgery after a negative PPRST at a tertiary referral center. Negative PPRST was defined by the absence of SUI during cough testing and urodynamic studies with prolapse reduction.
Results: Fifty-five patients were assessed in the final analy- sis. No significant complication was encountered during and after LSCP. Mean follow-up was 25±11 (range 12–48) months. No patient developed recurrent pelvic organ pro- lapse (POP) or mesh erosion at last follow-up. Thirty (54.5 %) patients reported the symptom of SUI (subjective SUI) postoperatively, 13 (23.6 %) had a positive cough test (objective SUI) at last visit, and nine (16.4 %) underwent a sling procedure. In univariate analyses, advanced cystocele (stage 3–4) and a history of patient-reported SUI before surgery were associated with a higher risk of postoperative subjective and objective SUI after LSCP. Multivariate anal- yses identified preoperative SUI as the sole independent predictor of subjective SUI [risk ratio (RR04.03; 95% con- fidence interval (CI)01.16–14.09), objective SUI, (RR0 4.67; 95% CI01.14–19.23), and subsequent anti-SUI sur- gery after LSCP (RR06.17; 95% CI01.30–29.41). Conclusions: SUI is far from uncommon in women after LSCP despite negative PPRST, especially in those with advanced cystocele and a history of SUI preoperatively; after at least 1 year of follow-up, approximately one in six women eventually underwent a sling surgery. These data are useful for counseling patients.