Do you routinely offer prophylactic mid-urethral sling in patients undergoing repair of significant prolapse without preop stress incontinence?

No— this was shown not to be beneficial and might cause more harm in the OPUS trial. (Wei et al., PMID 22716974)

I always discuss prophylactic sling with patients prior to prolapse repair. But there are a few things that influence whether I tend to discourage it or present it as a completely patient-determined decision. If the patient has no history of stress incontinence and I cannot elicit stress incontinenc...

Both landmark trials point in the same direction: adding a prophylactic procedure (Burch with abdominal sacrocolpopexy in CARE, midurethral sling with vaginal repair in OPUS) roughly halves the rate of postoperative stress incontinence compared with prolapse repair alone, and this holds whether the ...