Occult incontinence in women with pelvic organ prolapse - does it matter?

Abstract

ObjectiveMany surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery.Methods233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed.Results19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape.ConclusionThe incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.

The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study

“…But these are only qualitative, not quantitative analysis methods. The literature shows that the prevalence of OSUI ranges from 10.7 to 35.8 % in POP patients [11][12][13], and only 5.3-15.8 % of patients require subsequent MUSs after prolapse surgery [11,12]. Those outcomes are consistent with our data.…”

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

“…The two-step approach aims to correct the prolapse first and includes a postoperative evaluation to determine whether surgical correction of stress urinary incontinence (SUI) is needed. Our recently published data show that in a large cohort of 233 patients who underwent prolapse surgery, only 18 (7.7 %) complained of SUI 6 weeks to 6 months after surgery and were ultimately treated with tension-free vaginal tape (TVT) [15]. Considering that some of the prolapse surgeries may also serve as (transient) incontinence procedures, there is no information regarding the long-term prevalence of OSUI.…”

Long-term follow-up of the retropubic tension-free vaginal tape procedure

“…This result is in the lower (170). Furthermore, the number needed to treat with prophylactic TVT in order to prevent one preoperatively continent woman from having a subsequent TVT after POP surgery has been estimated in two randomized controlled trial to lie between 6 and 11 (101;139).…”