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'Sling' Implant May Cut Risk of Incontinence After Prolapse Surgery
Date:6/21/2012

time; the other received a "sham," or fake sling surgery. The women could not tell if they had the real or the fake surgery.

At three months, nearly half (49 percent) of women in the sham group reported incontinence, compared with 24 percent of those who got the sling surgery.

At 12 months, 43 percent in the sham group and 27 percent in the sling group had urinary incontinence.

"Because we saw superiority of putting in the sling at the time of the surgery, it would make sense to offer women the option of putting in a [preventive] sling at the time of the prolapse repair," Wei said.

The study is published in the June 21 issue of the New England Journal of Medicine.

Not all experts were so enthusiastic.

The study, a randomized, controlled clinical trial, was well done and provides valuable statistics to share with women trying to make a decision about whether to get one or both procedures, said Dr. Gunhilde Buchsbaum, a urogynecologist and professor at University of Rochester Medical Center, in New York. She offers women the option of doing the prolapse repair and the preventive incontinence surgery at the same time, or doing the prolapse repair and waiting to see if the patient is bothered by incontinence afterward.

"I think that the finding of these studies should be mainly used in counseling women and obtaining truly informed consent on whether or not one should place a sling in women at the time of prolapse surgery in women who otherwise have not complained of incontinence," Buchsbaum said.

But the risk of complications reported in the study should give women pause.

Nearly 7 percent of women had a bladder perforation and 3 percent experienced major bleeding in those who got the sling, while none in the prolapse-repair only group did. About 31 percent in the sling group developed a urinary tract infection, compared with 18 percent in the prolapse-repair only group. Another complication more common among
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