Urinary Incontinence and Pelvic Organ Prolapse in Women

Abstract

Background: Pelvic floor disorders are common, especially in pregnancy and after delivery, in the postmenopausal period, and old age, and they can significantly impact on the patient's quality of life.

Methods: This narrative review is based on publications retrieved by a selective search of the literature, with special consideration to original articles and AWMF guidelines.

Results: Pelvic floor physiotherapy (evidence level [EL] 1), the use of pessaries (EL2), and local estrogen therapy can help alleviate stress/urge urinary incontinence and other symptoms of urogenital prolapse. Physiotherapy can reduce urinary incontinence by 62% during pregnancy and by 29% 3-6 months post partum. Anticholinergic and β-sympathomimetic drugs are indicated for the treatment of an overactive bladder with or without urinary urge incontinence (EL1). For patients with stress urinary incontinence, selective serotonin-noradrenaline reuptake inhibitors can be prescribed (EL1). The tension-free tape is the current standard of surgical treatment (EL1); in an observational follow-up study, 87.2% of patients were satisfied with the outcome 17 years after surgery. Fascial reconstruction techniques are indicated for the treatment of primary pelvic organ prolapse, and mesh-based surgical procedures for recurrences and severe prolapse (EL1).

Conclusion: Urogynecological symptoms should be specifically asked about by physicians of all relevant specialties; if present, they should be treated conservatively at first. Structured surgical techniques with and without mesh are available for the treatment of urinary incontinence and pelvic organ prolapse. Preventive measures against pelvic floor dysfunction should be offered during pregnancy and post partum.

Figure 1:

a) Cystocele through a central fascial defect with flattening of the vaginal rugae and atrophic colpitis b) Cystocele through a lateral defect with preserved vaginal rugae and uterine prolapse

Figure 2

Mesh-assisted hysteropexy techniques: 1) sacrohysteropexy, 2) vaginal sacrospinous bilateral hysteropexy, 3) hysteropexy according to Dubuisson (mesh running retroperitoneally toward the ventrolateral abdominal wall), 4) pectopexy according to Noè.