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Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up

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Abstract

Introduction and hypothesis

Patients with genital prolapse and occult stress urinary incontinence (OSUI) are typically treated with prolapse surgery and anti-incontinence surgery based on either a one-step approach or a two-step approach. The aim of our study was to determine whether anti-incontinence surgery is necessary based on the occurrence of OSUI in a study cohort with a long follow-up period.

Methods

Prolapse surgery was performed using a vaginal approach. Preoperatively, a stress test, a pad test and an assessment of the urodynamics were performed with and without prolapse reduction. Over a follow-up period of 2–8 years, the patients with preoperative evidence of OSUI underwent urogynaecological examinations, stress tests and pad tests.

Results

Of 113 patients with preoperative evidence of OSUI, 57 (50.4 %) were followed up for an average of 5.7 years (range 2–8) after prolapse surgery. Of 57 patients, 16 (28.1 %) had objective and/or subjective stress urinary incontinence (SUI) during the follow-up period, but only 3 patients (5.3 %) required subsequent tension-free vaginal tape (TVT) surgery. In 17 of 57 patients (29.8 %), prolapse recurred.

Conclusions

Despite the preoperative evidence of OSUI, the manifestation of SUI rarely occurs, with 28.1 % of patients experiencing SUI over long-term follow-up after vaginal prolapse surgery. Anti-incontinence surgery was necessary in only three cases (5.3 %). These results indicate that with the one-step approach, 54 of 57 patients (94.7 %) would have received prophylactic anti-incontinence surgery unnecessarily. In conclusion, we recommend the two-step approach in the management of vaginal prolapse surgery in patients with OSUI.

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU — Innenstadt, Maistr. 11, 80337, Munich, Germany

    Stefanie Ennemoser, Mirjam Schönfeld, Vera von Bodungen, Darius Dian, Klaus Friese & Katharina Jundt

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  1. Stefanie Ennemoser
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  2. Mirjam Schönfeld
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  3. Vera von Bodungen
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  4. Darius Dian
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  5. Klaus Friese
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  6. Katharina Jundt
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Correspondence to Stefanie Ennemoser.

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Ennemoser, S., Schönfeld, M., von Bodungen, V. et al. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J 23, 851–855 (2012). https://doi.org/10.1007/s00192-012-1765-4

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  • DOI: https://doi.org/10.1007/s00192-012-1765-4

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