Dc. Chaikin et al., Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse, J UROL, 163(2), 2000, pp. 531-534
Purpose: We determined the indications for anti-incontinence surgery in con
tinent women undergoing surgical repair of severe urogenital prolapse.
Materials and Methods: We prospectively evaluated 24 continent women referr
ed for evaluation of severe urogenital prolapse. All patients underwent a m
eticulous clinical evaluation, including a complete history and physical ex
amination, urinary questionnaire, voiding diary, pad test, cotton swab test
, video urodynamics and cystoscopy. The urodynamic evaluation was repeated
with prolapse repositioning by a fitted vaginal pessary. Surgical intervent
ion was tailored according to urodynamic findings.
Results: Reduction of prolpase with a pessary unmasked sphincteric incontin
ence in 14 women (58%). Ten women with no urodynamic evidence of sphincteri
c incontinence underwent anterior colporrhaphy and no additional anti-incon
tinence procedure was performed. Mean followup was 44 months (range 12 to 9
6). None had postoperative stress incontinence but 1 (10%) had a recurrent
grade 2 cystocele, The 14 remaining women with sphincteric incontinence aft
er prolapse reduction underwent anterior colporrhaphy with a pubovaginal sl
ing 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 d
id not appear to be significantly influenced by either surgical interventio
n. Overall 12 patients had preoperative urge incontinence, of whom 9 (75%)
had persistent urge incontinence postoperatively. In another woman new onse
t urge incontinence developed.
Conclusions: Preoperative urodynamic evaluation with and without prolapse r
eduction is essential for making the correct diagnosis of masked stress inc
ontinence in women with urogenital prolapse. The decision to perform a conc
omitant prophylactic anti-incontinence procedure should be tailored to indi
vidual urodynamic findings. Larger series and longer followup are needed to
establish the most effective preventive procedure for this troublesome cli
nical problem.