(Poster 178) Patient Perspective on Stress Incontinence Management at Time of Prolapse Repair

Objectives: In patients undergoing pelvic organ prolapse (POP) repair, there is an established risk of de novo or worsening of stress urinary incontinence (SUI). Concomitant procedures for SUI commonly include synthetic mid-urethral sling (MUS) and urethral bulking (UBA) injection. Although studies have demonstrated prophylactic MUS efficacy and safety, prophylactic UBA outcomes are understudied, as is a consideration of what may guide patient decision making in choice of an anti-incontinence procedure. Importantly, patients without SUI who elect for prophylactic intervention represent a nuanced population in whom shared decision-making is particularly critical. This study aims to qualitatively explore patient perspectives on concomitant anti-incontinence procedures during POP repair and to identify factors influencing their treatment choices.

Methods: Patients were recruited from a urogynecologic tertiary referral center following decision for surgical repair of apical or anterior POP. All patients were counseled on concomitant anti-incontinence procedures irrespective of SUI symptoms. Telephone interviews were then conducted in English or Spanish.

Qualitative analysis utilized NVivo software with independent manual coding by researchers and coding output comparisons to mitigate bias. Focused coding was employed to refine emergent themes.

Results: Twelve participants (mean age 60 years; 11/12 White Hispanic) were interviewed. Four (33%) had occult or symptomatic SUI, and 8 (67%) had no SUI and were offered a prophylactic SUI intervention. 75% (n=6/8) of participants without SUI expressed concern regarding the development of de novo SUI following POP surgery. 62% (n=5/8) indicated they would desire or consider a prophylactic intervention for SUI prevention if it were offered as part of their surgery but 75% (n=6/8) still expressed limited understanding of available treatment options and reported insufficient knowledge to decide regarding a possible prophylactic treatment. Multiple themes emerged when patients described factors contributing to a concomitant SUI treatment decision, displayed in Table 1, notably their doctor's recommendations (42%) and treatment longevity (33%). Only 16% (n=2/12) of patients felt knowledgeable discussing UBA, while the remainder indicated they lacked sufficient knowledge to make informed, though hypothetical surgical decisions regarding UBA versus MUS.

Conclusions: Participants demonstrated a general interest in preventative treatments for SUI at the time of their index prolapse surgery. Prominent factors influencing decision-making included the anticipated treatment longevity and their doctor's recommendation. Despite standard preoperative counseling, information not directly related to their primary condition of prolapse was less well retained. Participants without SUI felt the least confident in their general knowledge of SUI treatment options, expressing uncertainty regarding hypothetical surgical decisions such as UBA versus MUS. This study underscores the importance of thorough preoperative surgical counseling, particularly in patients selecting a prophylactic concomitant SUI treatment with their prolapse repair.