Urogenital prolapse and occult stress urinary incontinence

Abstract

Background A 76-year-old female presented to an outside clinic with symptoms of pelvic prolapse; she denied stress urinary incontinence (SUI). The patient had a history of two prior anti-incontinence surgeries. Pelvic examination revealed a grade IV cystocele. No SUI was identified, with or without reduction of the prolapse. Anterior colporrhaphy with cadaveric fascia was performed. Her prolapse symptoms resolved, but she had new-onset severe SUI.

Investigations Pelvic examination, cystoscopy, urodynamics.

Diagnosis Occult SUI unmasked after anterior colporrhaphy.

Management The patient was referred to our institution where videourodynamics were performed, revealing a well-supported bladder and SUI with Valsalva leak-point pressure of 26 cm H20. A transvaginal polypropylene sling was placed. She had complete resolution of SUI and denied exacerbation of mild urgency.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Ghoniem GM et al. (1993) The value of the vaginal pack test in large cystoceles. J Urol 152: 931–934

  2. 2

    Hextall A et al. (1998) Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse? Int Urogynecol J Pelvic Floor Dysfunct 9: 205–209

  3. 3

    Romanzi LJ et al. (1999) The effect of genital prolapse on voiding. J Urol 161: 581–586

  4. 4

    Bump RC et al. (1988) The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. Obstet Gynecol 72: 291–295

  5. 5

    Richardson DA et al. (1983) The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol 146: 901–905

  6. 6

    Rodriguez LV et al. (2005) Transvaginal paravaginal repair of high-grade cystocele central and lateral defects with concomitant suburethral sling: report of early results, outcomes, and patient satisfaction with a new technique. Urology 66 (Suppl 5A): 57–65

  7. 7

    Mattox TF and Bhatia NN (1994) Urodynamic effects of reducing devices in women with genital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 5: 283–286

  8. 8

    Chaikin DC et al. (2000) Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 163: 531–534

  9. 9

    Klutke JJ and Ramos S (2000) Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol 182: 1378–1381

  10. 10

    Groutz A et al. (2004) Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases. Neurourol Urodyn 23: 632–635

  11. 11

    Liang CC et al. (2004) Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol 104: 795–800

  12. 12

    Brubaker L et al. (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354: 1557–1566

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kathleen C Kobashi.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Yamada, B., Kobashi, K. Urogenital prolapse and occult stress urinary incontinence. Nat Rev Urol 4, 55–58 (2007). https://doi.org/10.1038/ncpuro0699

Download citation

Further reading