Urodynamic outcome after surgery for severe prolapse and potential stress incontinence

OBJECTIVE: Women with severe prolapse may be paradoxically continent becaus e of kinking of the urethra. It is currently a common practice to perform u rethropexy in women who demonstrate stress incontinence on preoperative red uction of the prolapse with a pessary. We compared the urodynamic outcomes after reconstructive operations that included suspending urethropexy with o utcomes after those that did not. STUDY DESIGN: A review was performed of the charts of the Gynecologic Urolo gy Clinic at Los Angeles County-University of Southern California Women's a nd Children's Hospital from 1991-1997 of patients with grade III uterovagin al prolapse or procidentia in whom the pessary test was used to determine w hether urethropexy was included in the reconstructive operation. Urodynamic outcomes were compared statistically with the Fisher exact test, and P les s than or equal to .05 denoted statistical significance. RESULTS: Fifty-five patients underwent urethropexy in addition to repair of the prolapse, and 70 underwent reconstruction alone. Twenty-three patients in the first group and 20 in the second were available for a mean urodynam ic follow-up of 3.5 years. In the urethropexy group 7 (30%) patients had de novo detrusor instability and 1 (4%) had stress incontinence. In the recon struction-only group 1 (5%) patient had detrusor instability and none had s tress incontinence. CONCLUSIONS: Preoperative barrier testing is useful in identifying patients who do not require an anti-incontinence procedure. Prophylactic Burch retr opubic urethropexy increases the incidence of bladder instability.