The onset of stress urinary incontinence following surgical correction of pelvic organ prolapse (POP) worsens the quality of life for patients and increases healthcare resource expenditure. Moreover, combined correction of POP and a preventive anti-incontinence technique increases the cost of surgery and may be associated with adverse effects. 
Knowing the incidence of urinary incontinence (UI) after POP surgery in our population, as well as the predictive factors for its onset, will enable us to offer more individualized treatment to our patients, thereby improving outcomes, patient satisfaction, and optimizing the use of healthcare resources.
The main aims of the study are:
1. To know the incidence of persistent and de novo urinary incontinence in patients undergoing pelvic organ prolapse surgery, as well as the rate of cured previous incontinences.
2. To describe the predictive factors for the onset of urinary incontinence after POP surgery.

Design: 
Prospective multicenter descriptive study.
Materials:
Inclusion criteria
All patients over 18 years of age with symptomatic POP, eligible for surgical treatment according to medical criteria, and desiring such treatment. 
Inclusion criteria encompass patients with or without previous urinary incontinence surgery, as well as those with prior surgery for POP and/or incontinence.
Exclusion criteria
The only exclusion criterion is the inability to provide the necessary consent to participate in the study.
Methods:
The ethics committees of the participating centers have authorized their participation in the study.
The inclusion of patients began in April 2022 and concluded in January 2024.
All patients have been evaluated prior to surgery and signed informed consent for surgery and participation in the study. Subsequently, they are scheduled for follow-up according to each center's usual protocol one year after surgery for clinical evaluation. Data collected before surgery include: demographic characteristics, POP characteristics (POP-Q), presence of urinary incontinence based on commonly used questionnaires in the clinic (ICIQ-SF, Sandvik), urodynamics (if performed based on clinical criteria). At the 12-month visit, POP-Q stage, UI questionnaires (Sandvik, ICIQ-SF), urodynamics if urinary incontinence is present, and other relevant studies according to the patient's clinical presentation are assessed. All assessments are conducted according to the usual clinical practice of each participating center in the study. Predictive factors for the onset of urinary incontinence are identified based on this data.
Data are collected in a coded manner (relevant demographic and clinical data).
Data analysis is performed using SPSS software, using multivariable binary logistic regression models.

In this interim analysis, we have included 598 patients, of whom we have one-year data for 179 patients.
The baseline characteristics of the patients can be observed in Figure/Table 1.
410 (68.6%) patients have undergone surgery for anterior prolapse, 323 (54%) for upper vaginal prolapse, and 76 (12.7%) for posterior compartment prolapse. 
At 12 months, 13.6% of patients have presented with stress urinary incontinence (SUI), and 22.4% with urge urinary incontinence (UUI). 
Regarding the severity of SUI at one-year post-intervention, we observed that patients who experience SUI at the one-year mark after surgery exhibit a Sandvik score of 3 or less in 50% of cases, and the ICIQ-SF score is 7 or less in the same percentage.
It is worth noting that during the clinical follow-ups prior to one year, 8.4% of patients have experienced self-limited SUI, which had disappeared by the one-year follow-up. Similarly, 5.6% of patients have experienced self-limited urge urinary incontinence during the follow-up prior to 12 months, without it persisting at the one-year mark after surgery.
Only two patients have required surgery for SUI during this period of time.
The presence of prior stress urinary incontinence and urethral hypermobility are predictive factors for the presence of SUI at one year post-surgery (respectively, p=0.007 and p=0.042). Family history of urinary incontinence has also been associated with the risk of developing UI at one year post-surgery (p=0.015). No further predictive factors have been found among those analyzed.

9.6% of patients who did not have prior stress urinary incontinence and 26.8% of those who did have SUI before surgery present SUI at one year after surgery. However, 90.4% of patients who did not have prior SUI and 73.2% of those who did have SUI do not present SUI at the one-year follow-up. When present, the severity of incontinence was mainly slight and do no require a new surgery in the vast majority of cases.
For urge urinary incontinence at one year, it represents 8% of patients who did not have prior UUI and 50% of patients who did have UUI. 
Only three of the items analyzed in the multivariable analysis are independent predictive factors for the presence of urinary incontinence at one year post-prolapse surgery: The presence of stress urinary incontinence and urethral hypermobility before surgery, and the family history of urinary incontinence. This fact may be related to genetics, race, origin, or perhaps learned lifestyle.

In this interim analysis, in patients with genital prolapse, both the presence of stress urinary incontinence and urethral hypermobility prior to the intervention, as well as family history of urinary incontinence, are predictive factors for the presence of urinary incontinence at one year post-prolapse surgery in our population.

Continence 12S (2024) 101505
DOI: 10.1016/j.cont.2024.101505