Ml. Gallentine et Rd. Cespedes, Occult stress urinary incontinence and the effect of vaginal vault prolapse on abdominal leak point pressures, UROLOGY, 57(1), 2001, pp. 40-44
Objectives. To compare the difference in abdominal leak point pressures (AL
PPs) between patients with large cystoceles and severe vaginal vault prolap
se and to assess the frequency of occult stress urinary incontinence (SUI)
in these groups.
Methods. A total of 24 adult female patients with pelvic prolapse underwent
prospective fluorourodynamic testing to determine the change in ALPP with
and without reduction of the pelvic prolapse. Twelve patients had grade III
-IV vaginal vault prolapse and 12 had large cystoceles without vault prolap
se. ALPP testing was performed with the prolapse unreduced and then reduced
using gauze packing and a vaginal speculum.
Results. In patients with vault prolapse, the frequency of occult SUI was 5
0% (6 of 12) and the mean decrease in ALPP was 59 cm H2O after prolapse red
uction. In the patients with cystocele, all patients had overt SUI, and the
mean change in ALPP was 11 cm H2O after prolapse reduction. A component of
intrinsic sphincter deficiency was identified in 9 (75%) of 12 women with
vault prolapse after reduction, and 8 (66%) of 12 women with no vault prola
pse had a component of intrinsic sphincter deficiency before reduction, wit
h an additional 2 (17%) of 12 patients after reduction.
Conclusions. There is a high incidence of occult SUI in patients with vault
prolapse and the ALPP after reduction is decreased to a much greater degre
e in patients with vaginal vault prolapse than in patients with cystocele a
lone. By reducing the pelvic prolapse during urodynamic testing, an accurat
e ALPP can be obtained, allowing the appropriate incontinence procedure to
be performed. UROLOGY 57: 40-44, 2001. Published by Elsevier Science Inc.