Abstract: PD02-08
Sources of Funding: none

Introduction

There is a 44% risk of stress urinary incontinence (SUI) following sacral colpopexy and some advocate a concomitant sling to prevent this. Robotic Sacral Colpopexy (RSC) may carry a different risk of de-novo SUI and women may be just as satisfied with a delayed mid-urethral sling (MUS). This would reduce unnecessary MUS. We sought to determine this risk and evaluate the hypothesis that delayed MUS following RSC will have similar long term pad use, Quality of Life (QoL), Distress (UDI-6), and Impact scores (IIQ-7) compared to concomitant MUS.

Methods

Retrospective review was undertaken and subjects were grouped based on continence status at the time of RSC. Incontinence was defined by self-report at any follow up visit, SUI on the supine stress test, or decision for MUS.

Results

A retrospective review of the Indiana University RSC database between 2009 and 2015 identified 135 women who underwent RSC. 79 had no preoperative SUI and 29/79 (36.7%) of patients had at least one episode of de-novo SUI following RSC over a follow up of 17.9 months. 98 patients were evaluable post-operatively. 47/57 (82%) initially dry patients elected no concomitant MUS, and ultimately 5/47 (11%) of those chose a delayed sling at an average follow up time of 23.9 months. 10/57 (18%) preoperatively dry women elected to undergo a concomitant MUS at the time of RSC. Those undergoing delayed sling reported similar post-operative pad use, UDI-6, QoL, and IIQ-7 scores (Table 1) compared with those not undergoing a sling, suggesting that a delayed sling did not have a negative impact on QoL. Those choosing to undergo concomitant MUS reported more pads per day preoperatively (2.6 vs. 0.4) including pad use from urge incontinence. With regard to satisfaction the patients who were dry pre-operatively and chose no sling scored better (2.25 vs. 6.2, p<0.01) on the IIQ-7 compared with those choosing a concomitant sling.

Conclusions

Patients undergoing RSC without concomitant MUS have similar de-novo SUI rates to those undergoing open colpopexy. There appears to be no advantage to concomitant MUS at the time of RSC for women exhibiting no preoperative SUI.

Funding

none