Why is this study important?

FIN-POP (Karjalainen 2024) is one of the rare studies that assessed the rate of requiring surgery for stress urinary incontinence (SUI) following prolapse surgery.

Most surgeons already believe such rate is too high, justifying SUI surgery at the time of the original prolapse surgery. As a result, many women receive two procedures at the same time.

How was the study conducted?

FIN-POP is a population-based real-world observational data from Finland, relating to 2,677 Pelvic Organ Prolapse (POP) surgeries.

Women had an average age of 63.7 years and a BMI of 26.8kg/m2. They completed validated questionnaires before prolapse surgery and the rate of a second surgery to correct the incontinence was analysed at 2-year follow up.

What were the findings?

Before prolapse surgery, 50% of women experienced SUI.

Following surgery, the vast majority of SUI symptoms resolved or improved. Only 5.1% required surgery for persistent SUI.

Less than 1% underwent a procedure for new (de novo) SUI.

Risk Factors for Requiring SUI Surgery following Prolapse Surgery:

	Persistent SUI	De Novo
Increase ⬆️	Severe preoperative symptoms	Advanced age Preoperative urgency incontinence Mesh surgery
Decrease ⬇️	Advanced apical prolapse

The way forward

With only 5% subsequently requiring SUI surgery, the study challenges our belief that surgery for an already present SUI is required during prolapse surgery.

With no correlation between new SUI and the prolapsing compartment or preoperative stage, the study also addresses our concerns about the possibility that prolapse surgery can reveal an “occult” SUI condition by correcting the bladder prolapse.

If you believe this study applies to your population, let’s resist the temptation to offer SUI surgery at the time of prolapse surgery. This is particularly true for women with advanced uterine prolapse, the least likely to require such surgery subsequently.

The exception would be severe symptoms, as above, and if the woman is happy to accept the risks of two procedures at the same time.

Urodynamics is unlikely to be necessary for the vast majority of women before prolapse surgery. This is because such surgery is likely to resolve the SUI anyway, and highly unlikely to reveal any occult condition.