Comparing combined paravaginal repair with pubocervical fascia plication versus standard anterior colporrhaphy for the treatment of stress urinary incontinence in women with anterior vaginal wall prolapse: a randomised controlled trial.

Background: Stress urinary incontinence (SUI) is prevalent among women, often occurring alongside anterior vaginal wall prolapse. This study compares the efficacy and safety of an improved vaginal wall repair technique with pubocervical fascia fixation versus standard anterior colporrhaphy for treating SUI in women with anterior vaginal wall prolapse.

Methods: A single-centre, parallel-group, randomised controlled trial was conducted between September 2021 and June 2024. Women aged 40-70 years with symptomatic SUI and stage 2-3 anterior vaginal wall prolapse were randomised to either the improved repair group or the standard repair group. The primary outcome was patient-reported success at 12 months post-surgery, defined as 'very much improved' or 'much improved' on the Patient Global Impression of Improvement scale. Secondary outcomes included objective cure rates, quality of life scores, urodynamic parameters, anatomical outcomes, perioperative outcomes and adverse events.

Results: A total of 102 women were randomised (51 in each group). At 12 months, the patient-reported success rate was significantly higher in the improved repair group (94.1% vs 78.4%, p = 0.019). The objective cure rate was also higher in the improved repair group (90.2% vs 74.5%, p = 0.038). Quality of life scores and urodynamic parameters showed greater improvements in the improved repair group. Anatomical success was achieved in 92.2% of the improved repair group compared with 80.4% in the standard repair group (p = 0.048). The improved repair technique was associated with longer operative time but lower estimated blood loss, shorter hospital stay and quicker return to normal activities. The overall complication rate was lower in the improved repair group (11.8% vs 23.5%, p = 0.043).

Conclusions: The improved vaginal wall repair with pubocervical fascia fixation demonstrates superior outcomes compared with standard anterior colporrhaphy, with higher patient-reported success rates, improved quality of life and fewer complications.