The Value of the Vaginal Pack Test in Large Cystoceles

Abstract

To detect possible stress urinary incontinence associated with but masked by large cystoceles protruding through the vaginal orifice, a vaginal pack test was done in conjunction with video fluoro-urodynamic studies. Sixteen female patients with large cystoceles did not demonstrate stress urinary incontinence on clinical examination and were included in this study. Additionally, 10 healthy female volunteers underwent the same test to study the effect of a vaginal pack on urethral dynamics. The vaginal pack revealed the presence of stress urinary incontinence in 11 patients (69%): 3 (19%) with type II (vesicourethral hypermobility) and 8 (50%) with type III (internal sphincteric deficiency). After insertion of the vaginal pack, urodynamic studies showed that the closing proximal urethral pressure in patients with stress urinary incontinence was significantly lower than in continent patients (p < 0.05). No significant change in urethral pressures was noted in volunteer subjects after vaginal pack insertion. Fluoroscopy showed kinking of the posterior urethra and enlargement of the most dependent portion of the cystocele, that is the lower half of the hourglass image. Our study suggests that the mechanisms of continence in these patients are multifactorial, including urethral kinking, urethral compression and pressure dissipation. The vaginal pack test is easy to perform, increases visualization of the vesicourethral unit when used with fluoroscopy, and can aid in the selection of patients who would benefit from anti-incontinence surgery and/or cystocele repair.

Tension&ndash;Free Vaginal Mesh Repair for Anterior Vaginal Wall Prolapse

“…Two patients presented a de novo stress urinary incontinence after previous formal repair of cystocele. Urodynamic examination including leak point pressure evaluation [15]was performed in all patients to correctly evaluate and classify SUI before and after cystocele repositioning according to Ghoniem recomendations [16]. One patient was diagnosed as having type III SUI (instrinsic sphincteric deficiency) while the others presented a type II SUI (urethral hypermobility) before surgery.…”

Clinical correlates in patients not completing a voiding diary

“…Using the vaginal pack test for reduction of large cystoceles. Ghoniem et al found a 50% rate of type III (internal sphincteric deficiency) incontinence [14]. Lastly, 27% of patients undergoing surgical correction for their pelvic organ prolapse had coexistent genuine stress incontinence and detrusor overactivity with their prolapse reduced.…”

Comparison of Cystographic Findings of Intrinsic Sphincteric Deficiency with Urethral Hypermobility Causing Urinary Incontinence

“…The vesical pressure required to induce visible leakage was recorded as VLPP [6,8] . If a significant cystocele was present, a VLPP was measured with packing in the vagina in an attempt to avoid faulty elevations due to the obstructive nature of a cystocele [8,9] . A VLPP of !…”