Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse

David Chaikin, Asnat Groutz, Jerry G. Blaivas

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Purpose: We determined the indications for anti-incontinence surgery in continent women undergoing surgical repair of severe urogenital prolapse. Materials and Methods: We prospectively evaluated 24 continent women referred for evaluation of severe urogenital prolapse. All patients underwent a meticulous clinical evaluation, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test, cotton swab test, video urodynamics and cystoscopy. The urodynamics evaluation was repeated with prolapse repositioning by a fitted vaginal pessary. Surgical intervention was tailored according to urodynamics findings. Results: Reduction of prolapse with a pessary unmasked sphincteric incontinence in 14 women (58%). Ten women with no urodynamics evidence of sphincteric incontinence underwent anterior colporrhaphy and no additional anti- incontinence procedure was performed. Mean followup was 44 months (range 12 to 96). None had postoperative stress incontinence but 1 (10%) had a recurrent grade 2 cystocele. The 14 remaining women with sphincteric incontinence after prolapse reduction underwent anterior colporrhaphy with a pubovaginal sling procedure. Mean followup in these cases was 47 months (range 12 to 108). In 2 patients (14%) stress incontinence developed postoperatively and 1 (7%) had a recurrent grade 3 cystocele. The incidence of urge incontinence did not appear to be significantly influenced by either surgical intervention. Overall 12 patients had preoperative urge incontinence, of whom 9 (75%) had persistent urge incontinence postoperatively. In another woman new onset urge incontinence developed. Conclusions: Preoperative urodynamic evaluation with and without prolapse reduction is essential for making the correct diagnosis of masked stress incontinence in women with urogenital prolapse. The decision to perform a concomitant prophylactic anti-incontinence procedure should be tailored to individual urodynamic findings. Larger series and longer followup are needed to establish the most effective preventive procedure for this troublesome clinical problem.

Original languageEnglish (US)
Pages (from-to)531-534
Number of pages4
JournalJournal of Urology
Volume163
Issue number2
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

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Pelvic Organ Prolapse
Urodynamics
Urge Urinary Incontinence
Prolapse
Cystocele
Pessaries
Cystoscopy
Physical Examination
History
Incidence

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

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title = "Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse",
abstract = "Purpose: We determined the indications for anti-incontinence surgery in continent women undergoing surgical repair of severe urogenital prolapse. Materials and Methods: We prospectively evaluated 24 continent women referred for evaluation of severe urogenital prolapse. All patients underwent a meticulous clinical evaluation, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test, cotton swab test, video urodynamics and cystoscopy. The urodynamics evaluation was repeated with prolapse repositioning by a fitted vaginal pessary. Surgical intervention was tailored according to urodynamics findings. Results: Reduction of prolapse with a pessary unmasked sphincteric incontinence in 14 women (58{\%}). Ten women with no urodynamics evidence of sphincteric incontinence underwent anterior colporrhaphy and no additional anti- incontinence procedure was performed. Mean followup was 44 months (range 12 to 96). None had postoperative stress incontinence but 1 (10{\%}) had a recurrent grade 2 cystocele. The 14 remaining women with sphincteric incontinence after prolapse reduction underwent anterior colporrhaphy with a pubovaginal sling procedure. Mean followup in these cases was 47 months (range 12 to 108). In 2 patients (14{\%}) stress incontinence developed postoperatively and 1 (7{\%}) had a recurrent grade 3 cystocele. The incidence of urge incontinence did not appear to be significantly influenced by either surgical intervention. Overall 12 patients had preoperative urge incontinence, of whom 9 (75{\%}) had persistent urge incontinence postoperatively. In another woman new onset urge incontinence developed. Conclusions: Preoperative urodynamic evaluation with and without prolapse reduction is essential for making the correct diagnosis of masked stress incontinence in women with urogenital prolapse. The decision to perform a concomitant prophylactic anti-incontinence procedure should be tailored to individual urodynamic findings. Larger series and longer followup are needed to establish the most effective preventive procedure for this troublesome clinical problem.",
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Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. / Chaikin, David; Groutz, Asnat; Blaivas, Jerry G.

In: Journal of Urology, Vol. 163, No. 2, 01.01.2000, p. 531-534.

Research output: Contribution to journalArticle

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