«Primum non nocere». Hippocrates pelvic organ prolapse and occult stress incontinence

This article presents an overview of current literature on the results of surgical treatment of pelvic organ prolapse in combination with occult stress urinary incontinence. Topical issue is clinical significance of preoperative determination of occult incontinence, choice of the method of diagnosis (reduction of pelvic organ prolapse, urodynamics) and the significance of preventive anti-stress operation during surgical correction of pelvic organ prolapse for prevention the occurrence of stress incontinence de novo. Results of surgical treatment of pelvic organ prolapse by vaginal and abdominal approaches vary in frequency of postoperative stress incontinence, therefore they should be considered separately. Nowadays, unified algorithm for determining the indications and timing of performance additional anti-stress operations has not been developed, according to that, the choice to use more anti-stress operation entirely based on the collective decision of both the surgeon and the patient. Comprehensive preoperative assessment of patients during planning surgical treatment of pelvic organ prolapse could reduce the risk of postoperative complications, particularly stress urinary incontinence. In this regard, there is the necessity to develop a uniform diagnostic algorithm based on anatomical and functional assessment of the urethra in women with pelvic organ prolapse, which would offer the most optimal system approach in selection of treatment of this condition.