SURGERY FOR GENITOURINARY PROLAPSE AND STRESS-INCONTINENCE - A RANDOMIZED TRIAL OF POSTERIOR PUBOURETHRAL LIGAMENT PLICATION AND PEREYRA SUSPENSION

OBJECTIVE: Our purpose was to compare two antiincontinence procedures in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence. STUDY DESIGN: In addition to cystop exy, 109 patients with a urethrocystocele of grade 2 or more and a pos itive stress test result with prolapse reduction received posterior pu bourethral ligament plication or Pereyra suspension. RESULTS: Of 55 pa tients undergoing posterior pubourethral ligament plication, 15 were c linically and 40 potentially incontinent; the same figures were 21 and 33, respectively, among 54 patients undergoing the Pereyra procedure. Follow-up was for 3 to 9 years. Subjective (60% vs 71%, p = 0.72) and objective (27% vs 57%, p = 0.14) cure rates were not statistically di fferent among patients who were clinically incontinent (posterior pubo urethral ligament plication vs Pereyra suspension). Among potentially incontinent patients, subjective (85% vs 100%, p = 0.03) and objective (50% vs 76%, p = 0.04) continence rates were higher after the Pereyra procedure. Overall, the cotton swab test had negative results (maximu m straining angle less than or equal to 30 degrees) after successful s urgery in 79% and 96%, respectively, of patients (p = 0.03). Four subj ects (7%) underwent removal of one Pereyra suture because of urinary r etention or suprapubic wound infection. CONCLUSION: Cystopexy with Per eyra suspension is recommended, particularly for patients with prolaps e and potential stress incontinence.