Ringing the changes in evaluation of urogenital prolapse

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Surgical Outcomes

Background:

• Pelvic organ prolapse (POP) can coexist with occult urodynamic stress incontinence (OUSI).
• Women undergoing POP surgery may develop stress urinary incontinence (SUI) postoperatively if OUSI is present.
• Accurate preoperative identification of OUSI is crucial for patient counseling and surgical planning.

Purpose of the Study:

• To evaluate the predictive value of a ring pessary test during urodynamics for identifying OUSI.
• To determine the likelihood of developing SUI after POP surgery based on the pessary test results.

Main Methods:

• 112 women with POP were recruited from surgical lists.
• All participants underwent preoperative videocystourethrography (VCU).
• The VCU was repeated after POP reduction using a ring pessary for women with initially normal VCU results.

Main Results:

• The pessary test demonstrated high specificity (93%) and excellent negative predictive value (98%) for predicting postoperative SUI.
• Sensitivity was moderate (67%), and the positive predictive value was low (40%).
• Of 48 women with normal initial VCU, 43 without OUSI had only 1 instance of postoperative SUI, while 5 with OUSI had 2 instances of frank SUI.

Conclusions:

• The ring pessary test is a valuable tool for identifying patients likely to remain continent after POP surgery.
• This test can significantly aid in preoperative counseling for women with POP.
• The high specificity and negative predictive value suggest its utility in ruling out postoperative SUI.