The predictive value of demonstrable stress incontinence during basic office evaluation and urodynamics in women without symptomatic urinary incontinence undergoing vaginal prolapse surgery

Aims To review the current literature on the development of latent stress urinary incontinence (SUI) or SUI that occurs following pelvic organ prolapse therapy in patients who were continent prior to therapy. To make recommendations on how to best evaluate and manage patients with pelvic organ prolapse who are continent. Methods This is a narrative review using Google scholar and cross referencing identified manuscripts. We used the British Medical Journals grading of literature to assign letter grades to level of statements and recommendations. Results The literature suggest about 40% of women with advanced pelvic organ prolapse who are continent will develop SUI after surgery to correct their pelvic organ prolapse. Reduction cough stress testing can help identify those patients at risk to develop SUI with a PPV of 60%. Reduction cough stress testing is best done using large rectal swabs or scopettes. The literature on how to best manage patients with advanced pelvic organ prolapse and are continent to avoid latent SUI is mixed and the best recommendations are based on sound literature that is incomplete. Conclusions Understanding that latent SUI is a potential complication in any subject with advanced pelvic organ prolapse is necessary to pre‐operative counseling. Deciding on the best management strategy is not clear cut and therefore should involve patient input in the decision making process.

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

A narrative review of the epidemiology, diagnosis, and treatment of latent stress urinary incontinence

Edenfield

Patnam

Swift³

2019

“…1 Women with occult SUI before prolapse surgery (urinary leakage observed only after reduction of the prolapse) also have a higher risk of reporting POSUI as compared with women without occult SUI. [2][3][4] To reduce the risk of POSUI, one might consider combining prolapse surgery with an incontinence procedure. Combination surgery reduces the risk of POSUI compared with prolapse surgery only.…”

Section: Introductionmentioning

confidence: 99%

“…Although the stress test is commonly used to identify women with a high POSUI risk, its value is questionable. 2,5 Jelovsek et al 5 developed a model for predicting the risk of de novo SUI after prolapse surgery and published an online calculator. Their model is applicable to women without preoperative SUI symptoms, which is about 50% of the women undergoing prolapse surgery.…”

Section: Introductionmentioning

confidence: 99%

Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test

Ploeg

Zwolsman

Vaart

et al. 2019

Self Cite

Objective To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test. Patients and methods Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO‐1, n = 134) and without (CUPIDO‐2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability. Results Three hundred fifty‐six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<−1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2‐4.6) in the extended model, which increased the optimism‐corrected area under the receiver‐operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI. Conclusion A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.

Cough stress tests to diagnose stress urinary incontinence in women with pelvic organ prolapse with indication for surgical treatment

Espuña‐Pons

Diez-Itza

Anglès‐Acedo

et al. 2020

Aims: To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams.Methods: Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires. Results: A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m 2 , respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046). Conclusions:The identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL. K E Y W O R D Scough stress test, pelvic organ prolapse, stress urinary incontinence ---