Evaluating the Necessity of TOT Implantation in Women With Pelvic Organ Prolapse and Occult Stress Urinary Incontinence (ATHENA)

• To compare the postoperative prevalence of stress incontinence in patients with or without TOT implant during a pelvic organ prolapse surgery [ Time Frame: 6 month ] [ Designated as safety issue: Yes ]
  

• To compare the severity of postoperative stress urinary incontinence between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the prevalence of new onset overactive bladder postoperatively between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the severity of new onset overactive bladder between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the prevalence of postoperative dyspareunia at 6 months between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the prevalence of postoperative urinary retention between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the severity of postoperative dyspareunia at 6 months between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the prevalence of dyschesia and constipation at 6 months between the two groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare pre- and postoperative urodynamic test of patients when they are incontinent at 6 months [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  
• To compare the postoperative Patient Global Impression of Improvement and degree of satisfaction at 6 months between the 2 groups [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  

The study population consists of women with pelvic organ prolapse and occult stress urinary incontinence. They are randomised within two groups : one group with pelvic organ prolapse surgery alone and one group with implantation of TOT together with prolapse surgery for prevention of stress urinary incontinence.TOT implantation is performed as described previously, while the pelvic organ prolapse surgery could either be of abdominal (open or laparoscopic) or vaginal approach. Eighty eight (88) patients will be enrolled at 3 sites centers.

This study is a prospective, multicenter, randomised, active-control arm trial. The study population consists of women with pelvic organ prolapse and occult stress urinary incontinence. They are randomised within two groups : one group with pelvic organ prolapse surgery alone and one group with implantation of TOT together with prolapse surgery for prevention of stress urinary incontinence.TOT implantation is performed as described previously, while the pelvic organ prolapse surgery could either be of abdominal (open or laparoscopic) or vaginal approach. Eighty eight (88) patients will be enrolled at 3 sites centers.

Visit I (J-2 months +/- 1 month) :

During this visit the following will be performed :

• Collection of general medical, obstetric and surgical history of the patients

• Collection of incontinence, prolapse and sexual history with the following questionnaires :

  • Standard Questionnaire
  • PFIQ-7 : Pelvic Floor Impact Questionnaire
  • PFDI-20 : Pelvic Floor Distress Inventory-short version Questionnaire
  • PISQ-12 : Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

• Clinical examination that includes :

  • a stress test in lithotomy position before and after reduction of prolapse with bladder filled with 250 cc of water. The reduction of prolapse will be performed manually and using a vaginal speculum. The results after both types of reduction will be recorded separately
  • a Vaginal examination establishing the oestrogen status of patient's vagina and classification of prolapse using Baden Walker halfway method and modified ICS POP-Q system
  • Urodynamic test that includes Uroflowmetry as follows :
  • urethral pressure profile, maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP) determination before and after reduction of prolapse manually
  • Filling cystometry without reduction of prolapse Post void residual volume of urine will be recorded
  • Explanation of the research protocol
  • Evaluation criteria for inclusion and exclusion
  • Information and signed informed consent of the patient
  • Randomization

Hospitalization (J0 at J 6days +/- 2 days) :

During the stay in the hospital the following will be recorded:

• Type and duration of each procedure
• Total number of days of hospitalization
• Immediate complications (e.g perioperative hemorrhage requiring transfusion or not, urine retention requiring catheterisation)
• Postvoid residual volume of urine for all the patients by bladder scan

Visit II (J 45 days +/- 15 days) :

During this visit the following will be performed :

• Objective and subjective evaluation of POP treatment and TOT placement

• Filling out questionnaires :

  • PFIQ-7 : Pelvic Floor Impact Questionnaire
  • PFDI-20 : Pelvic Floor Distress Inventory-short version Questionnaire

• Clinical examination including :

  • Stress test in lithotomy position as of visit I
  • Vaginal examination
  • In case of prolapse, the modified ICS POP-Q and Baden Walker halfway method for quantification

Visit III (J 6 months +/- 1 month) :

During this visit the following will be performed :

• Filling out questionnaires :

  • PFIQ-7 : Pelvic Floor Impact Questionnaire
  • PFDI-20 : Pelvic Floor Distress Inventory-short version Questionnaire
  • PISQ-12 : Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire
  • PGI-I : Patient Global Impression of Improvement
  • Degree of satisfaction by the operation (visual 0-10 scale)

• Clinical examination including :

  • Stress test in lithotomy position as of visit I
  • Vaginal examination
  • In case of prolapse, the modified ICS POP-Q and Baden Walker halfway method for quantification
• Uroflowmetry
• Short time pad test
• Full urodynamic test in case of incontinence or obstruction