Top

International Urogynecology Journal

Published in:

01-07-2012 | Original Article

Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery

Authors: Rune Svenningsen, Ellen Borstad, Anny Elisabeth Spydslaug, Leiv Sandvik, Anne Cathrine Staff

Published in: International Urogynecology Journal | Issue 7/2012

Abstract

Introduction and hypothesis

Recommending prophylactic anti-incontinence procedures to continent women undergoing surgery for pelvic organ prolapse (POP) is controversial. We hypothesized that testing for occult incontinence before surgery using four different tests and three defined test combinations would identify individual women at risk for postoperative stress urinary incontinence (POSUI). The diagnostic accuracy of these tests and test combinations were evaluated.

Methods

We tested 137 women before and after surgery. Fisher’s exact test was used when evaluating associations between test results and outcomes. The validity of each test and test combinations was calculated.

Results

We found a statistically significant association between occult incontinence and POSUI in two tests and all test combinations. However, all tests and test combinations displayed poor performance when predicting at individual levels.

Conclusions

This study confirms a positive association between occult incontinence and POSUI. Occult incontinence does not, however, adequately identify individual women in need of prophylactic anti-incontinence surgery when undergoing POP repair.

Borstad E, Rud T (1989) The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 68:545–549PubMed

Brubaker L, Cundiff GW, Fine P et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354:1557–1566PubMedCrossRef

Ellstrom Engh AM, Ekeryd A, Magnusson A, Olsson I, Otterlind L, Tobiasson G (2011) Can de novo stress incontinence after anterior wall repair be predicted? Acta Obstet Gynecol Scand 90:488–493PubMedCrossRef

Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D (2004) Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases. Neurourol Urodyn 23:632–635PubMedCrossRef

Visco AG, Brubaker L, Nygaard I et al (2008) The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 19:607–614PubMedCrossRef

Liang CC, Chang YL, Chang SD, Lo TS, Soong YK (2004) Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol 104:795–800PubMedCrossRef

Ghoniem GM, Walters F, Lewis V (1994) The value of the vaginal pack test in large cystoceles. J Urol 152:931–934PubMed

Gordon D, Groutz A, Wolman I, Lessing JB, David MP (1999) Development of postoperative urinary stress incontinence in clinically continent patients undergoing prophylactic Kelly plication during genitourinary prolapse repair. Neurourol Urodyn 18:193–197PubMedCrossRef

Gregorio G, Hillemanns HG (1990) Urethral closure function in women with prolapse. Int Urogynecol J 1:143–145CrossRef

10.

Klutke JJ, Ramos S (2000) Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol 182:1378–1381PubMedCrossRef

11.

Richardson DA, Bent AE, Ostergard DR (1983) The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol 146:901–905PubMed

12.

Rosenzweig BA, Pushkin S, Blumenfeld D, Bhatia NN (1992) Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse. Obstet Gynecol 79:539–542PubMed

13.

Bergman A, Koonings PP, Ballard CA (1988) Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. Am J Obstet Gynecol 158:1171–1175PubMed

14.

Kulseng-Hanssen S, Borstad E (2003) The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG 110:983–988PubMedCrossRef

15.

Bossuyt PM, Reitsma JB, Bruns DE et al (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Clin Chem Lab Med 41:68–73PubMedCrossRef

16.

Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P (2004) Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 159:882–890PubMedCrossRef

17.

Daneshgari F, Kong W, Swartz M (2008) Complications of mid urethral slings: important outcomes for future clinical trials. J Urol 180:1890–1897PubMedCrossRef

18.

deTayrac R, Gervaise A, Chauveaud-Lambling A, Fernandez H (2004) Combined genital prolapse repair reinforced with a polypropylene mesh and tension-free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case–control study with short-term follow-up. Acta Obstet Gynecol Scand 83:950–954CrossRef

19.

Ballert KN, Biggs GY, Isenalumhe A Jr, Rosenblum N, Nitti VW (2009) Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol 181:679–684PubMedCrossRef

20.

Chaikin DC, Groutz A, Blaivas JG (2000) Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 163:531–534PubMedCrossRef

21.

Kleeman S, Vassallo B, Segal J, Hungler M, Karram M (2006) The ability of history and a negative cough stress test to detect occult stress incontinence in patients undergoing surgical repair of advanced pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 17:27–29PubMedCrossRef

22.

Brubaker L, Nygaard I, Richter HE et al (2008) Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol 112:49–55PubMedCrossRef

23.

Myers DL, Lasala CA, Hogan JW, Rosenblatt PL (1998) The effect of posterior wall support defects on urodynamic indices in stress urinary incontinence. Obstet Gynecol 91:710–714PubMedCrossRef

Title: Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery
Authors: Rune Svenningsen
Ellen Borstad
Anny Elisabeth Spydslaug
Leiv Sandvik
Anne Cathrine Staff
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 7/2012
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1764-5

At a glance: The STEP trials

Springer Medicine

Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2012

Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study

Pelvic floor muscle strength predicts stress urinary incontinence in primiparous women after vaginal delivery

The role of anti-incontinence surgery in management of occult urinary stress incontinence

Effectiveness of midurethral slings in recurrent stress urinary incontinence: a systematic review and meta-analysis

Urogynecology digest

Can pelvic floor injury secondary to delivery be prevented? Comment