Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse?

Abstract

The aim of the study was to evaluate the use of a vaginal pessary in the detection of genuine stress incontinence (GSI) in women with urogenital prolapse undergoing urodynamic investigation. Continent women with urogenital prolapse, with or without associated urinary symptoms, were studied. All underwent videocystourethrography using a standardized protocol. None had evidence of incontinence on provocative testing in the upright position. A well-fitting vaginal ring pessary was inserted to reduce the prolapse and mimic a vaginal repair. The provocative tests were then repeated while the bladder was screened. Seventy women with a mean age 59.0 years (range 34-83) were recruited over a 21-month period: 15 women complained of prolapse alone and 55 had concurrent urinary symptoms; 19 women (27%) developed GSI only following the insertion of a vaginal pessary. The women who became incontinent were significantly older (mean age 63.9 years) than those who remained continent (mean age 56.8 years) (P < 0.020). The use of a vaginal pessary increases the detection rate of GSI in continent women with urogenital prolapse undergoing videocystourethrography. These findings are important because women with prolapse and coexisting incontinence should be offered a continence procedure rather than a simple vaginal repair.

Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse?

“…All vaginal examinations were performed in left lateral position and with an emptied bladder, as described by the International Continence Society (ICS). For the urodynamic evaluation, a vaginal pessary was used to reduce the prolapse and detect occult urodynamic stress incontinence [22].…”

Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up

“…The underlying cause may be urethral compression or urethral kinking [1]. The percentage of patients in whom evidence of OSUI is discovered prior to prolapse surgery varies from 27 to 68 % [2,3,4]. Optimal preoperative diagnostic testing may play an important role for the selection of the best individualised surgical strategy in women with genital prolapse.…”

Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair

“…Median parity was 2.5 (range 0-4) and body mass index 23 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Eleven women were premenopausal, 32 were on treatment with hormone replacement therapy preoperatively, and 114 (59%) were sexually active.…”