A case report of anterior vaginal prolapse: the use of tension-free sling

Abstract

Occult incontinence occurring after surgery for anterior vaginal wall prolapse may be a stressful unmasked condition which may lead to a second surgical approach. For this reason extremely careful selection of patients should be done prior surgery which should treat in the same time either the prolapse and the asymptomatic urethral hypermobility or the intrinsic sphincteric deficency. We report the case of a 59-year-old female presented with symptoms of pelvic prolapse; she denied stress urinary incontinence (SUI). The patient was referred to our institution where videourodynamics were performed, revealing a grade IIb cystocele (POP-Q), a QTip test of 50° and a negative Valsalva leak-point pressure test. She had no history of prior anti-incontinence surgeries. Pelvic examination identified no SUI, with or without reduction of the prolapse. Anterior colporrhaphy with transobturatory sub-urethrovesical placement of a new composite polypropylene tension-free sling was performed. Her prolapse symptoms resolved, with no new-onset of SUI. At 2 year follow-up she had complete resolution of prolapse and denied SUI or de novo detrusor instability urgency.