Hello, and I hope I can help you today. If you have both a cystocele and urinary incontinence, when they perform the operation to raise up your urethra with a sling, if your anterior vaginal wall (which is what makes the cystocele) is still collapsing down then you may actually not be able to urinate after the sling procedure because the angle at which your bladder comes off your urethra is much greater than 30°. This is effectively kinking your urethra (imagine bending a straw to an angle where the straw folds on itself and liquid can no longer pass). So for this reason, most incontinence specialists recommend having a cystocele repair at the same time as urethral sling procedure. If you also have vaginal prolapse, you may still have a bulge that protrudes from the vagina if you do not have that corrected at the time of your sling procedure. The vaginal prolapse itself should not affect your incontinence, however it may mean that you may need another operation down the road if you do not have this treated as well at the time of your surgery. So in summary, I do agree with your physician that having a cystocele repair would give you the best result over the long-term in treating or urinary incontinence. Regarding your vaginal prolapse, it depends upon the degree and whether you are symptomatic as to whether it is necessary to perform that part of the procedure. However, most doctors recommend treating any other areas of prolapse within the vagina to prevent later prolapse symptoms needing another operation. I hope that I was able to adequately answer your question today, and that this information was helpful. Best wishes, Dr. Brown