RANDOMIZED PROSPECTIVE COMPARISON OF NEEDLE COLPOSUSPENSION VERSUS ENDOPELVIC FASCIA PLICATION FOR POTENTIAL STRESS-INCONTINENCE PROPHYLAXIS IN WOMEN UNDERGOING VAGINAL RECONSTRUCTION FOR STAGE-III OR STAGE-IVPELVIC ORGAN PROLAPSE

OBJECTIVE: Severe prolapse may mask potential genuine stress urinary i ncontinence in women. Some have suggested that a suspending urethropex y be performed in women who have potential genuine stress incontinence demonstrated by barrier reduction of the prolapse preoperatively. Our aim waste compare outcomes after prolapse surgery that included a nor mal bladder neck suspension with those operations that did not. STUDY DESIGN: This prospective randomized clinical trial assigned 32 women w ith bladder neck hypermobility and stage III or IV pelvic organ prolap se to receive either a needle colposuspension or bladder neck endopelv ic fascia plication as part of the vaginal reconstructive surgery. Twe nty-nine subjects underwent detailed clinical, anatomic, urodynamic, a nd quality-of-life evaluations before and 6 weeks and 6 months after s urgery; 23 completed urinary diary and quality-of-life evaluations aft er a mean of 2.9 years. RESULTS: Needle colposuspension increased shor t-term complications without providing additional protection from de n ovo stress incontinence. Barrier testing before surgery predicted uret hral sphincteric resistance after surgery; however, such testing neith er predicted a patient's function after surgery nor indicated the need for a suspending urethropexy. The combination of a needle colposuspen sion with a sacrospinous ligament suspension predisposed to the early development of support defects of the upper anterior vaginal segment a nd to failure of bladder neck support. CONCLUSIONS: Preoperative barri er testing in women with severe prolapse is not useful in identifying individuals who require a suspending urethropexy. Needle colposuspensi on increases short-term complications, lacks durability, and may predi spose to early and severe recurrent anterior prolapse when performed w ith a sacrospinous ligament vault suspension.