Surgical Replacement of the Uterosacral- and Pubourethral-Ligaments as Treatment for Urgency Urinary Incontinence

Aim: The bilateral replacement of the uterosacral ligaments was developed for the treatment of female pelvic organ prolapse. The aim of the present study was to evaluate the effect of this treatment on Mixed Urinary Incontinence (MUI) and Urgency Urinary Incontinence (UUI) in patients with minor prolapse. Materials and Methods: This was a retrospective study of 71 women suffering from MUI and UUI. Previous conservative treatments had failed. They were operated by Cervico-Sacropexy (CESA) or Vagino-Sacropexy (VASA). All patients had apical vaginal prolapse (POP-Q stage I - II). Urinary incontinence was classified according to validated urinary incontinence questionnaires. The outcome was evaluated 4 months after surgery. Patients who were still urinary incontinent received an additional Transobturator Tape (TOT). The final outcome was assessed 4 months thereafter. Results: 71 patients suffering from MUI and UUI with POP-Q stage I - II were surgically treated by CESA (n=26) and VASA (n=45). After CESA and VASA, the apical vaginal prolapse was repaired in all patients. 16 patients (62%) of the CESA group and 15 patients (33%) of the VASA group were cured of their urinary incontinence. The uncured patients agreed to an additional TOT and 53% of them were cured after this procedure. An overall cure rate for MUI and UUI of 77% was obtained by CESA and 71% by VASA. Conclusion: Besides the repair of genital prolapse, the bilateral replacement of the uterosacral ligaments by CESA or VASA cured 33% to 62% of patients who suffered from MUI and UUI. After a TOT an overall cure rate ranging from 71% to 77% was observed