Urodynamics are necessary for patients with asymptomatic pelvic organ prolapse

To evaluate the role of pre-operative urodynamics in women with pelvic organ prolapse, who are asymptomatic for urinary symptoms. Correlate urodynamics findings with King's Health Questionnaire (KHQ) responses.

Retrospective review of prospectively collected data on routine pre-operative urodynamics investigations in women with urogenital prolapse requiring surgery. Patients who were reported to be asymptomatic of urinary symptoms at the urogynaecological clinical consultation, were included for analysis. KHQ and urodynamics data were reviewed.

A 800 records of women having routine pre-operative urodynamics were collected over a 10-year period, were reviewed. 98/800 (12%) were aymptomatic of urinary symptoms and underwent urodynamics. 82/98 (84%) completed the KHQ. 48/98 (49%) had normal urodynamics. 30/98 (31%) had detrusor overactivity (DO). 17/98 (17%) showed occult urodynamic stress incontinence (USI). 3/98 (3%) both DO and USI. 28/98 (29%) had peak flow rate less than 15 mL/s. Forty-five percent of women reporting nocturia had DO. Nine percent had over 100 mL residuals after the free flow study. Routine pre-operative urodynamics changed management in 25/98 (25%) of asymptomatic prolapse patients. TVT was performed in 12 patients. One patient who declined TVT for moderate occult USI, developed new-onset stress urinary incontinence post-operatively.

This data show, that an accurate pre-surgical evaluation of patients with prolapse is incomplete without a structured validated questionnaire and urodynamics, due to the high proportion of abnormal KHQ and UDS findings in presumably "asymptomatic" patients.