Female Urology – Incontinence Must Colposuspension be Associated with Sacropexy to Prevent Postoperative Urinary Incontinence? Elisabetta Costantini a, *, Alessandro Zucchi a , Antonella Giannantoni a , Luigi Mearini a , Vittorio Bini b , Massimo Porena a a Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, Unit of Urogynaecology, University of Perugia, Perugia, Italy b Department of Internal Medicine, University of Perugia, Italy european urology 51 (2007) 788–794 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted August 22, 2006 Published online ahead of print on September 5, 2006 Keywords: Colposuspension Prolapse Sacropexy Urinary stress incontinence Abstract Objectives: This prospective, randomised study investigated whether a pro- phylactic procedure, performed during colposacropexy for prolapse repair, prevents ex novo postoperative incontinence. Sixty-six consecutive conti- nent patients with advanced prolapse were randomised into two groups: group A underwent sacropexy combined with a Burch colposuspension; no anti-incontinence procedure was performed in group B patients. Methods: Work-up included clinical assessment (Halfway System and Inter- national Continence Society [ICS] classification for prolapse and Ingelman Sunderberg scale for incontinence), the Urogenital Distress Inventory and Impact Incontinence Quality of Life questionnaires, urogynaecologic ultra- sound scans, and complete urodynamic testing that included the urethral pressure profile and Valsalva leak point pressure with reduced prolapse. Check-ups were done at 3, 6, 12 mo postoperatively and then yearly. Mean follow-up time was 39.5 mo. Results: The mean age ( standard deviation) was 62  9 yr. All patients presented with grade (G) 3–4 prolapse. Postoperative incontinence was present in 12 of the 34 patients in group A: 7 G1; 4 G2, and 1 G3. Postoperative incontinence was present in 3 of the 32 patients in group B: 2 G1, 1 G3. The frequency of postoperative incontinence was significantly greater in patients who had undergone colposuspension ( p < 0.05). Conclusions: These preliminary data cast doubt on whether colposuspen- sion should be performed during sacropexy for severe urogenital prolapse as prophylaxis for postoperative incontinence because it seems to emerge as overtreatment. Incontinence developed ex novo in 35% of continent patients treated with colposuspension combined with sacropexy. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Urology Department, University of Perugia, Via Brunamonti 51, 06100 Perugia, Italy. Tel. +39 075 5783198; Fax: +39 075 5726123. E-mail address: ecostant@unipg.it (E. Costantini). 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.08.034