**6. Staged or concomitant procedures for treating pelvic organ prolapse and stress urinary incontinence**

Currently, choosing either a concomitant or stepwise approach to treat concurrent pelvic organ prolapse and stress urinary incontinence is still debatable. A proper balance between the risk of incomplete treatment and exposing a patient to an unnecessary operation requires consideration when explaining the treatment outcomes to the patient. Some surgeons recommend concomitant procedures to treat co-existing stress urinary incontinence and pelvic organ prolapse in order to avoid the possibility of secondary surgery. However, they may encounter some inherent risks and unexpected adverse effects such as postoperative voiding difficulty, bladder outlet obstruction, and/or de novo detrusor overactivity. Others prefer staged procedures to correct pelvic organ prolapse first, followed by re-evaluation for the presence of stress urinary incontinence after the wound has healed and stabilized (Gordon et al., 2001; Huang et al., 2005; Winters JC, 2008; Wu et al., 2010). As mentioned before, anterior colporrhaphy might also cure stress urinary incontinence and its success rate is as high as 60% (Jarvis 1994). Intuitively, staged procedures most likely prevent two-thirds of unnecessary procedures for incontinence when contrasted with concomitant operations.
