Combined stress urinary incontinence surgery at the time of prolapse surgery – is it justified?

Objectives. To review the current literature in order to formulate an evidence-based approach to the problem of preventing stress urinary incontinence (SUI) following prolapse surgery. Design. We reviewed the current English language literature available on PubMed (Medline), as well as current relevant textbooks in print. Results. It appears that a prophylactic anti-incontinence procedure is justified in patients with pre-operative SUI, as well as in those with a positive stress test at reduction. In patients with no pre-operative evidence of occult SUI, management is still controversial. Conclusions. Further research is needed, specifically with regard to standardisation of the stress test, the place of suburethral slings and the role of pelvic floor ultrasound.