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.
Subscribe to Journal
Get full journal access for 1 year
only $17.75 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Ghoniem GM et al. (1993) The value of the vaginal pack test in large cystoceles. J Urol 152: 931–934
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
Romanzi LJ et al. (1999) The effect of genital prolapse on voiding. J Urol 161: 581–586
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
Richardson DA et al. (1983) The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol 146: 901–905
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
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
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
Klutke JJ and Ramos S (2000) Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol 182: 1378–1381
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
Liang CC et al. (2004) Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol 104: 795–800
Brubaker L et al. (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354: 1557–1566
The authors declare no competing financial interests.
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
Current Opinion in Urology (2010)
Incontinencia urinaria oculta evidenciada por estudio urodinámico preoperatorio en pacientes con prolapso genital severo
Actas Urológicas Españolas (2008)