Strategy of Delayed Midurethral Sling Surgery for Pelvic Organ Prolapse with Stress Urinary Incontinence after Laparoscopic Lateral Abdominal Wall Suspension.

Abstract

<h4>Introduction and hypothesis</h4>To explore whether concurrent midurethral sling surgery (MUS) is necessary for pelvic organ prolapse (POP) patients with simple anatomical stress urinary incontinence (SUI) undergoing laparoscopic lateral abdominal wall suspension (LLS).<h4>Methods</h4>A multicenter prospective cohort study enrolled 200 eligible patients (stage Ⅱ + apical/anterior POP with SUI) from 2022-2024, divided into LLS + MUS (n = 100) and LLS alone (n = 100), with 40 healthy controls. Outcomes included urodynamic tests, ISI, POP-Q, MRI, and PGI-I at baseline, 3 months, and 1 year.<h4>Results</h4>170 patients (85%) completed 1-year follow-up. LLS + MUS group had higher SUI cure rate (85.3% vs 50.9%, P < 0.05) but more complications (urinary tract infection:17.6% vs 5.9%; urinary retention:8.8% vs 0%; dyspareunia:35.3% vs 15.7%; mesh exposure:14.7% vs 2%, all P < 0.05). LLS alone group showed higher satisfaction (86.3% vs 67.6%, P < 0.05). POP anatomical reduction rates were similar between groups (P > 0.05).<h4>Conclusions</h4>For apical/anterior POP with SUI, LLS alone is preferred, with delayed MUS if needed, reducing complications and improving satisfaction.