Intervention · n = 165
Prophylactic TVT Sling
Retropubic midurethral sling (Gynecare TVT) placed during vaginal prolapse repair
Control · n = 172
Sham Incisions
Two 1-cm suprapubic incisions mimicking trocar sites — no sling placed
6.3
Number Needed to Treat (12 months)
For every 6–7 women who receive a prophylactic sling at the time of prolapse repair, one case of urinary incontinence is prevented at 1 year.
Primary Outcome — Urinary Incontinence Rate
ⓘ
Preoperative stress test did not determine benefit. Sling reduced incontinence regardless of whether the prolapse-reduction cough stress test was positive or negative. Only 33.5% of women had a positive test preoperatively.
Safety — Higher Adverse Events with Sling
⚠
Bladder Perforation
6.7% vs 0% (P < 0.01)
⚠
UTI
31.0% vs 18.3% (P = 0.008)
⚠
Major Bleeding
3.1% vs 0% (P = 0.03)
⚠
Voiding Dysfunction at 6 wk
3.7% vs 0% (P = 0.01)
✓
No Mesh Erosions
0% in both groups — no sling-related mesh complications observed
Take-Home Message
In women without stress incontinence symptoms undergoing vaginal prolapse repair, a prophylactic retropubic midurethral sling cuts postoperative urinary incontinence nearly in half — but at the cost of more bladder perforations, UTIs, and voiding dysfunction. This is a shared decision-making conversation: the benefit (NNT 6.3) must be weighed against the patient's individual risk tolerance.