VIDEOURODYNAMIC DIAGNOSIS OF OCCULT GENUINE STRESS-INCONTINENCE IN PATIENTS WITH ANTERIOR VAGINAL WALL RELAXATION

OBJECTIVE: To (1) utilize videourodynamics, the gold standard, to asse ss the prevalence of occult genuine stress incontinence (GSI) among pr eoperative patients with symptomatic anterior vaginal wall relaxation and (2) identify urodynamic discriminators that might help predict occ ult GSI. METHODS: In this prospective study, videourodynamic evaluatio n was performed on 48 consecutive patients presenting for preoperative urodynamic evaluation of anterior vaginal wall prolapse. Patients wit h occult GSI were identified by urodynamic testing with and without Ge hrung pessary support of the bladder base during stress maneuvers. Var iables from the history, physical examination, and videourodynamics we re then analyzed. RESULTS: The overall incidence of occult GSI was 25% (22.7% in the pelvic organ prolapse [POP] group and 26.9% in the POP- UI group). Patients with occult GSI were not identifiable on history b ut did have a higher incidence of late first sensation, open bladder n eck at rest, and hypermobility on imaging with videourodynamics. CONCL USION: This study suggests that one quarter of women presenting with a nterior wall relaxation with or without incontinence symptoms have occ ult GSI. Given this high prevalence, preoperative evaluation with urod ynamics, possibly videourodynamics, utilizing bladder bare support is justified if the data are substantiated in a larger, definitive study. Patients with a late first sensation, open bladder neck, and hypermob ility may have a higher incidence of occult GSI. Copyright (C) 1998 by the Society for Gynecologic Investigation.