The evaluation of the effect of simultaneous urinary incontinencesurgery on treatment success, incontinence, sexual function, and Prolapserelated quality of life in patients undergoing surgery for pelvic organ prolapse

Objective: In this study, it was aimed to evaluate the effect of simultaneous urinary incontinence (UI) surgery on treatment success, stress urinary incontinence (SUI) test, sexual function, and life quality were evaluated in patients who underwent surgery for pelvic organ prolapse (POP) by the help of different scales. Materials and Methods: The study included 94 patients who underwent surgery for UI and POP in tthe Obstetrics and Gynecology Department of Düzce University Faculty of Medicine between September 2017 and May 2022. POP-Q staging was performed after an informed consent was taken from every patient in this study. The Prolapse Quality of Life Scale (P-QOL), the Incontinence Quality of Life Scale (IQOL), The Pelvic Organ Prolapse/Urine Incontinence Sexual Function Questionnaire (PISQ-12), The International Incontinence Inquiry Short Form Turkish Version (ICIQ-SF), and the Bristol Female Lower Urinary Symptom Index (BFLUTS scales were filled in by the clinician according to patient's pre-operative and post-operative status. In patient selection, the distinction was made between those who had UI surgery and those who had simultaneous POP surgery with UI surgery. İn this study. Group 1 consisted of patients who had minisling, transvaginal tape (TVT) and transobturator tape (TOT) surgery and Group 3 consisted of patients who had vaginal hysterectomy (VAH) or corporaphy anterior (CA) added to TOT, minisling, 4-arm mesh surgeries. Results: The mean age of the participants was 58.45±10.8 years. The median time after gynecological surgery was 41 months. When the groups are examined, in the group 1, there were 43 participants in total, 20 of who have minislings, 6 people who have TVT surgery, and 17 participants who have TOT surgery procedures. These 43 participants constitute 45.7% of the total participants. In the group 2, there were 23 participants who had VAH surgery, there were 16 participants who had TOT surgery, and there were 7 participants who had minisling surgery. When the postoperative POP-Q evaluation was performed on the participants who had POP surgery, the prolapse levels did not change based on the the selected surgery procedures. When the POP-Q measurements of the patients were examined, a statistical difference was found between the two groups in Aa measurement in the postoperative period (p=0.001). Based on this result, the mean Aa measurement in Group-1 was -1.8±1.1, the mean Aa measurement in Group-2 was -0.2±1.6. This statistical difference was attributed to the susceptibility of patients in Group-2 to POP. Regarding the SUI test, no statistically significant difference was found between the groups (p=0.140). The PISQ-12 emotional and partner subscales of participants in Group-1 did not show a statistically significant difference before and after the surgery. However, a statistically significant decrease was found in PISQ-12 physical subscale and total scores (p<0.001; p<0.001) in the group 1. Moreover, a statistically significant decrease was found in the PISQ-12 emotional, partner, physical subscales and total scores of the participants in Group-2 (p<0.001; p<0.001; p<0.001; p<0.001). For a next step analysis, as the variables in the binary logistic regression analysis performed by accepting the postoperative SUI test results as success or failure of the participants. Age, parity, having cesarean section, time since menopause, surgery groups were used as variables in this analysis. As a result of the study, the factors affecting postoperative UI were found as parity and the year since menopause (respectively; β= 0.452, p=0.04; β=-0.121, p=0.04). Conclusion: It was found that the application of simulatneous POP and SUI surgeries together is effective in especially in the physical area of sexual functions. Additionally, UI surgery and POP+UI surgery seem to reduce lower urinary symptoms and improve patients' quality of life. In the group that had POP and UI surgery together, the recurrence rates and the number of complications of stress and mixed UI were found as quite low, although a long time passed after the operation. In conclusion, simultaneous application of UI surgery with POP surgery seems to be a good option in patients with stress and mixed UI.