Single-incision Versus Retropubic Mid-Urethral Sling (Solyx) for SUI During Minimally Invasive Sacrocolpopexy

Inclusion Criteria:

• At least 21 years of age

• Vaginal bulge symptoms as indicated by an affirmative response of >1 to question 3of the PFDI-SF20

• POP ≥ stage II according to the pelvic organ prolapse quantification (POP-Q)system45, with evidence of apical descent

• Women being considered for minimally invasive sacrocolpopexy (with or withoutconcomitant hysterectomy)

• Objective SUI: positive standardized cough stress test on clinical examination or onurodynamic study with reduced prolapse

• Understanding and acceptance of the need to return for all scheduled follow-upvisits and willing to complete study questionnaires

• Able to give informed consent

Exclusion Criteria:

• Prior surgery for stress urinary incontinence including mid-urethral sling;Burch/MMK; fascial pubovaginal sling (autologous, xenograft or allograft); andurethral bulking injection

• Any serious disease, or chronic condition, that could interfere with the studycompliance

• Unwilling to have a synthetic sling

• Untreated and unresolved urinary tract infection

• Poorly-controlled diabetes mellitus (HgbA1c > 9 within 3 months of surgery date)

• Neurogenic bladder/ pre-operative self-catheterization

• Elevated post-void residual/PVR (>150 ml) that does not resolve with prolapsereduction testing (pessary, prolapse reduced uroflow or micturition study)

• Prior pelvic radiation

• Inflammatory bowel disease

• Current genitourinary fistula or urethral diverticulum

• Planned concomitant bowel related surgery including sphincteroplasty and perinealrectal prolapse surgery, rectovaginal fistula repair, hemorrhoidectomy

• Pregnant or Planning to Conceive

• Incarcerated