The present study aimed to comprehensively assess the prevalence of urinary incontinence (UI) in female patients undergoing laparoscopic reconstructive surgery, specifically Sacrocolpopexy (SCP), and to evaluate their postoperative outcomes. 
Our primary goal was to investigate the incidence of SUI before and after surgery and to explore the necessity for additional anti-incontinence procedures following laparoscopic SCP.

This multicentric observational study spanned from March 2011 to December 2019 and involved collaboration among five expert centers. Female patients aged 18 years and older with symptomatic stage II or higher Pelvic Organ Prolapse (POP), as classified by the POP-Q system, were eligible for inclusion. We specifically focused on patients who underwent laparoscopic SCP using a standardized lightweight and macroporous mesh device (Uplift®) without concurrent anti-incontinence procedures. We meticulously evaluated the prevalence of postoperative UI and the requirement for corrective surgery during the 1-year follow-up period. Statistical analysis, conducted using SPSS 22.0, encompassed descriptive analysis for continuous variables and frequency analysis for categorical variables.

Our analysis encompassed a total of 325 laparoscopic SCP procedures. The median age of patients was 66 years (interquartile range [IQR]: 61-73), with a mean BMI of 26.9 (standard deviation [SD]: 4.05). Preoperatively, 129 patients (39.7%) reported experiencing stress urinary incontinence (SUI), among whom 64 patients (19.7%) presented with pure SUI, while 65 patients (20%) had mixed urinary incontinence (MUI). Additionally, 59 patients (10.2%) exhibited pure urgency urinary incontinence (UUI). Postoperatively, 75 patients (24.3%) reported SUI, 15 patients (4.9%) experienced UUI, and 7 patients (2.3%) presented with MUI, summing up to 82 patients with urinary incontinence. These results are summarised in Figure #1.
21 patients required treatment for urinary incontinence, including 18 patients (5.5%) who underwent mid-urethral sling (MUS) procedures, and 3 patients who received botulinum toxin intravesical injections for overactive bladder syndrome. The use of MUS is summarised in Figure #2.

Out of the 129 patients with pre-existing stress urinary incontinence, only 18 required subsequent surgery for incontinence, specifically mid-urethral sling placement.
While laparoscopic SCP is a well-established surgical intervention for patients with severe POP, the debate regarding the need for concomitant anti-incontinence techniques persists in the literature. 
Our study contributes valuable insight by demonstrating a significant reduction in postoperative urinary incontinence, thus potentially obviating the need for additional surgical interventions and minimizing associated risks. Continuous monitoring of urinary outcomes is crucial for refining evidence-based recommendations.

Laparoscopic SCP represents an effective approach for addressing both severe POP and symptomatic UI, delivering notable improvements in genital and urinary symptoms while minimizing additional procedural risks.

Comprehensive evaluation and continuous monitoring of urinary outcomes are imperative for optimizing treatment strategies and enhancing patients' quality of life.

Further research is essential to validate these findings and refine therapeutic modalities, thereby advancing pelvic floor surgery.

Continence 12S (2024) 101503
DOI: 10.1016/j.cont.2024.101503