الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Introduction Pelvic-organ prolapse (POP) , a condition characterized by a downward descent of the pelvic organs, causing the vagina to protrude (Jelovsek , et al.2007) Anterior colporraphy is still the standard of care for anterior POP. The most important outcome of a surgical procedure ,from patient’s perspective , is the relief of symptoms and improvement in HRQOL (Barber, et al. 2009). In recent years , there was a rapid spread for the use of mesh for repair of pelvic organ prolapse. Transvaginal permanent mesh is associated with lower rates of reoperation for prolapse than native tissue repair however, it is associated with mesh exposure and higher rates of bladder injury at surgery and de novo stress urinary incontinence (Altman, et al. 2011) (Maher, et al. 2016) In July 2011 , the U.S. Food and Drug Administration (FDA) released a safety communication entitled ”UPDATE on Serious Complications Associated with transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse.” to inform health care providers and patients that serious complications with placement of this mesh are not rare and that it is not clear that these repairs are more effective than nonmesh repair (Stanford E and Moen M. 2011). Prospective studies of traditional anterior colporrhaphy for the treatment of cystocele have reported success rates of 37–57% (Sand, et al. 2001,Weber, et al. 2001) while polypropylene mesh surgery success rates were reported to reach 87% (Nguyen and Burchette 2008). In a multicenter RCT , the mesh repair for POP has a higher rate of treatment success than traditional colporrhaphy (60.8% vs. 34.5%) (Altman,et al. 2011). Stress urinary incontinence (SUI) represents the most common form of urinary incontinence, occurring in pure or mixed forms in nearly 80% of women with incontinence (Hunskaar 2004; Rogers 2008). The estimated lifetime risk of surgery for either SUI or POP in women is20.0% by the age of 80 years , although the cumulative risk for SUI surgerywas 13.6% (95% CI 13.5-13.7) and that for POP surgery was 12.6% (95% CI12.4-2.7) (Wu, J.M., et al., 2014). The published studies focused on the outcome of transvaginal mesh versus the standard anterior colporraphy in the treatment of anterior POP. The value of midurethral sling in treating both the prolapse and incontinence symptoms is of value to delineate. Is it enough to put amidurethral sling to cure both bothering symptoms? Aim of the work In this study, we aimed at comparing the anatomical and functionaleffectiveness of traditional anterior colporrhaphy versus combined anterior colporraphy and midurethral sling in the treatment of low grade cystocele in women with stress urinary incontinence (SUI) in a randomized controlled trial, taking into account quality of life considerations during evaluation. Materials and methods It’s a randomized controlled trial for patients with low grade POP who has concomitant SUI. The patients were randomly allocated into either MUS sling alone or combined MUS and anterior colporraphy. Inclusion criteria: 1. Age older than 21 years. 2. Symptomatic POP is the leading symptom concomitant with SUI. 3. Cystocele is of grade 1 or grade. 4. Patient life expectancy is greater than 10 year. 5. Normal upper tract. 6. Physically active patient. Exclusion criteria: 1. Recent pelvic or vaginal surgery within 6 months. 2. Neurological disorders that affect bladder and urethral functions. 3. Predominant urge incontinence. 4. Cystocele more than grade 2. 5. Evidence of obstructed flow in absence of prolapse. 6. Associated urethral pathology, e.g. Urethral divetriculum 7. Associated bladder pathology e.g. Fistula. 8. Active urinary tract infection as evidenced by positive urine culture. Pre-operative evaluation: involves History & examination (local PV examination) , Non invasiveflowmetry and PVR and Pressure flow study. Operative : Anterior colporraphy and MUS (PVFS , TVT , TOT) the success rate for POP is defined as absence of vaginal bulge and/or stage o or 1 according to POP-Q grading(Natale, et al. 2009) while the The SUI cure rate was defined and evaluated using clinical stress test and one hour pad test. Conclusion The cure rate of low grade anterior pelvic organ prolapse concomitant with SUI using MUS alone is comparable to combined MUS and anterior colporraphy. The MUS is effective and not inferior to standard anterior colporraphy in the treatment of low grade anterior POP.