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

Ennemoser, Stefanie; Schönfeld, Mirjam; Bodungen, V von; Dian, Darius; Friese, Klaus; Jundt, Katharina

doi:10.1007/s00192-012-1765-4

Cited by 45 publications

(23 citation statements)

References 22 publications

(25 reference statements)

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“…As noted by Ennemoser et al, 28.1% of patients with OSUI developed POSUI after a period of 5.7 years. 30 But in our study none of the patients developed POSUI. This difference may be due to short term follow up.…”

Section: Discussioncontrasting

confidence: 60%

“…Hence they recommended the two-step approach in the management of vaginal prolapse surgery in patients with OSUI. 30 In a study by Klutke and Ramos et al, the prophylactic Burch colposuspension increased the incidence of UI. Hence they had suggested the requirement of preoperative testing to identify the women who require an anti-incontinence procedure.…”

Section: Discussionmentioning

confidence: 97%

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Study of occult stress urinary incontinence in pelvic organ prolapse

Reddy

Ghose

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common health-related conditions. They affect up to 50% women worldwide individually.1 Stress urinary incontinence is a condition of involuntary loss of urine on effort, physical exertion, sneezing, or coughing that is often bothersome to the patient and frequently affects the quality of life. It is estimated to affect 15.7% of adult women.2 Many times this urinary incontinence is detected following corrective prolapse surgery. If a woman with pelvic organ prolapse leaks only when the prolapse is reduced, it is called occult stress urinary incontinence (OSUI). 3The prevalence of OSUI in women with severe genitourinary prolapse varies from 27-68% in literature. 4,5 If any previously continent woman develops urinary incontinence after vaginal hysterectomy and pelvic floor repair, it is a frustrating condition for both the patient and the physician.So it is important to counsel symptomatically continent women with POP for developing post-operative SUI (POSUI). Bump RC et al and Fianu et al have showed that POP, may mask SUI. 6,7 The colpopexy and urinary reduction efforts(CARE) study, the largest randomized trial, showed that 45% of women with POP developed POSUI subjectively and objectively as well. [8][9][10] In a study ABSTRACT Background: Pelvic organ prolapse and stress urinary incontinence are two common health-related conditions. If a woman with pelvic organ prolapse leaks only when the prolapse is reduced, it is called occult stress urinary incontinence (OSUI). The prevalence of OSUI in women with severe genitourinary prolapse varies from 27-68% in literature. In this study we want to find out the relationship between OSUI and stress urinary incontinence (SUI) following corrective surgery.The objectives of the study are to determine the number of women with urinary leak following reduction of prolapse before surgery; to determine the number women with occult stress urinary incontinence developing stress urinary incontinence following surgery and to determine the risk of developing stress urinary incontinence after vaginal hysterectomy and pelvic floor repair in these women. Methods: This is a longitudinal observational study. All women with pelvic organ prolapse (POP) of grade II or higher requiring corrective surgery were initially evaluated for OSUI using vaginal pack and followed up post operatively at 6 weeks and 12 weeks using QUID to look for post-operative stress urinary incontinence (POSUI). Results:The overall incidence of OSUI in our study was 7.5%. OSUI was significantly associated with factors like older age, higher BMI, high parity, short inter pregnancy interval and higher grade of prolapse and not significantly associated with factors like place of delivery, delivery events and mode of delivery. Conclusions:It is important to test all women with POP for OSUI and patients with OSUI need long term follow up to detect POSUI

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 97%

Study of occult stress urinary incontinence in pelvic organ prolapse

Reddy

Ghose

2017

Int J Reprod Contracept Obstet Gynecol

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“…6,7,31,35,49,50 Based on the five studies including asymptomatic women (19/85) and those included in our meta-analysis (27/124), we estimated roughly that, overall, about 22% (46/209) of the women with de novo SUI would request a subsequent anti-incontinence procedure. 6,7,10,11,24,27,31,49,50 This meta-analysis showed that the incidence of adverse events related to tape placement was higher in the group undergoing combination surgery relative to vaginal prolapse surgery only. There are two possible reasons for this increased risk: (1) the presence of POP is an isolated risk factor for the development of a complication; and/or (2) with the addition of a surgical procedure, the risks also increase.…”

Section: Interpretation In the Light Of Other Evidencementioning

confidence: 99%

“…[3][4][5] The risk is assumed to be highest (up to 80%) in the 20-30% of continent women with occult SUI, and is believed to be associated with kinking or compression of the urethra by the prolapse. [3][4][5][6][7] The combination of prolapse surgery with an anti-incontinence procedure to treat or prevent SUI is frequently considered in three patient groups: (1) women with coexisting SUI; (2) women asymptomatic for SUI; and (3) women asymptomatic for SUI with occult SUI.…”

Section: Introductionmentioning

confidence: 99%

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

Ploeg

Steen

Rengerink

et al. 2014

BJOG

110

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Objectives The combination of prolapse surgery with an incontinence procedure can reduce the incidence of stress urinary incontinence (SUI) after surgery, but may increase adverse events. We compared the effectiveness and safety of prolapse surgery versus combined prolapse and incontinence surgery in women with pelvic organ prolapse.Design and setting Pubmed, EMBASE, DARE, the Cochrane Library and the register of Current Controlled Trials were searched for randomised trials (restricted to Burch colposuspension and midurethral sling as incontinence procedure) from 1995 to 2013 limited to the English literature.Methods Two reviewers selected eligible articles and extracted the data. Pooling for SUI was based on three patient groups: (1) women with coexisting SUI; (2) women asymptomatic for SUI; and (3) women with occult SUI. For adverse events, pooling was based on incontinence procedure.Main outcome measures The primary outcome was SUI. The secondary outcomes were treatment for SUI, bladder storage symptoms, obstructive voiding and adverse events.Results Seven trials were included. Pooling for women with coexisting SUI was possible for objective SUI with two studies and showed no difference. Statistical (I 2 = 95%) and clinical heterogeneity was, however, high. The largest study showed a lower incidence of persisting SUI (5% versus 23%) and treatment for this (0% versus 57%) in women who underwent prolapse repair with a midurethral sling. The second study did not find a difference in women undergoing a sacrocolpopexy with or without Burch colposuspension. In asymptomatic women, combination surgery resulted in a lower incidence of de novo subjective SUI (two studies; 24% versus 41%; relative risk [RR], 0.6; 95% confidence interval [CI], 0.3-0.9; I 2 = 36%) and the need for subsequent anti-incontinence surgery (three studies; 2% versus 7%; RR, 0.4; 95% CI, 0.2-0.8; I 2 = 13%). For the outcome objective SUI, pooling was possible for five studies, but statistical heterogeneity was high (I 2 = 82%) and the difference was not statistically significant. In the subgroup of women with occult stress incontinence, we found a lower incidence of objective SUI after combination surgery (two studies; 22% versus 52%; RR, 0.4; 95% CI, 0.3-0.8; I 2 = 32%). There were no differences in bladder storage symptoms, urgency incontinence or long-term obstructive voiding symptoms. Adverse events (two studies; 15% versus 10%; RR, 1.6; 95% CI, 1.0-2.5; I 2 = 0%) and prolonged catheterisation (three studies; 6% versus 1%; RR, 4.5; 95% CI, 1.5-13.3; I 2 = 0%)were more frequent after vaginal prolapse repair with a midurethral sling.Conclusions Combination surgery reduces the risk of postoperative stress incontinence, but short-term voiding difficulties and adverse events were more frequent after combination surgery with a midurethral sling.Keywords Burch colposuspension, meta-analysis, midurethral sling, pelvic organ prolapse, review, stress urinary incontinence.Please cite this paper as: van der Ploeg JM, van der Steen A, Oude Rengerink K, va...

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“…In the follow-up period (mean 31 months) SUI was reported in 71.4 % in the TVT group and 77.3% in the TOT group of patients. Average satisfaction level was 9 (range 1-10) In a study by Ennemoser and colleagues at the Department of Obstetrics and Gynecology, University of Munich, Germany in 2012 on patients with pelvic organ prolapse surgery, the rate of stress incontinence was 28.1% in the follow-up period which only 5.3% of the patients required further surgery for incontinence (22). In our study complained of urinary incontinence in patients with prophylactic surgery in 3 patients (10%) were found in patients without prophylactic surgery of urinary incontinence after surgery, 5 patients (16.66%) were in patients with prophylactic surgery than patients without prophylactic surgery, but this difference was not significant.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Performing and Not-Performing the Prophylactic Surgery for Urinary Incontinence in Advanced Pelvic Organ Prolapse

Bastani¹,

Shoari²,

Hajebrahimi³

et al. 2014

IJWHR

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IntroductionPelvic prolapse is the downward and forward movement of a pelvic member towards its natural place and pelvic prolapse is displacement of the bladder, cervix, urethra, or rectum due to defects in pelvic support system. This condition is one of the most common abnormalities among older women. Urogenital prolapse is a common finding in 30% of women attending gynecologic of outpatient clinic (1-2) and affects up to 50% of women over 50 years (1,3). Up to 50% of women who had vaginal delivery suffer from degrees of prolapse, which is symptomatic only at the 20% of patients (4,5). In a study conducted in 1990 in America, it was reported that vaginal prolapse is the most common indication for hysterectomy in women over 50 (6). Urethral descent usually is seen with posterior and anterior wall of vagina/enterocele. Common symptoms include urinary frequency, urgency, incontinence, urinary increasing time of urination, feeling of incomplete emptying of the bladder and weak urinary flow. Posterior vaginal wall prolapse symptoms include disposal problems associated with prolonged excretion of urine, feeling of incomplete emptying of the bladder, constipation and fecal discharge with finger (1). Feeling of something coming down and sexual and urinary symptoms generally described as symptoms of prolapse especially in young women due to inadequacy of urethra (7). Most women with advanced anterior vaginal prolapse do not suffer from incontinency (1,8). Women who have severe pelvic prolapse may also have severe stress urinary incontinence (SUI). Reduction of prolapse during urodynamic assessments reveals non symptomatic cases of SUI in the 36 to 80% of women with advanced urogenital prolapse (1,9,10). Some recommend an anti-incontinency preventive procedure with prolapse restoration for prevention of post-operative urinary incontinence, but some do not recommend such a procedure (11)(12)(13)(14). For the First time in 1995 Ulmsten and Petros introduced a procedure to support the midsection of urethra without creating tension (15) providing a two-year cure rate of 84%. Since then this method which is named as tension free vaginal tape is used widely. Detayrace and colleagues reported 1 AbstractObjectives: To compare the Performing and not-performing of prophylactic surgery for urinary incontinence in women with pelvic organ prolapse. Materials and Methods: In a randomized controlled clinical trial that performed in department of Gynecology and Obstetrics of Tabriz University of Medical Sciences on women with advanced pelvic organ prolapse without history of urinary incontinence. The effects of performing and not-performing of prophylactic surgery for urinary incontinence in women with advance pelvic organ prolapse evaluated. Results: Mean age of patients was 53.83±5.52 years in the range of 41-66 years. Mean ICIQ-SF questionnaire scores at the first three questions in patients with pelvic organ prolapse with prophylactic surgery was 0.50±1.54 and in patients with pelvic organ prolapse without prophylactic surgery was 0...

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

Cited by 45 publications

References 22 publications

Study of occult stress urinary incontinence in pelvic organ prolapse

Study of occult stress urinary incontinence in pelvic organ prolapse

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

Comparison of Performing and Not-Performing the Prophylactic Surgery for Urinary Incontinence in Advanced Pelvic Organ Prolapse

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