Preoperative Urodynamics in Pelvic Organ Prolapse to Identify Postoperative Incontinence

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Surgical Outcomes

Background:

• Stress urinary incontinence (SUI) can be masked by pelvic organ prolapse (POP), leading to latent SUI or worsening after POP surgery.
• Preoperative urodynamic (UD) testing is used to identify hidden urinary dysfunctions, but its routine use and predictive value are debated.

Purpose of the Study:

• To identify urodynamically latent SUI in women undergoing POP surgery.
• To evaluate de novo SUI rates and incontinence outcomes postoperatively.
• To assess the predictive value of preoperative UD for postoperative SUI.

Main Methods:

• Retrospective cohort study of 261 women undergoing POP surgery with selective preoperative UD and postoperative follow-up.
• Latent SUI defined as urine loss during UD with prolapse reposition in patients without diagnosed SUI.
• Outcomes assessed via questionnaires, clinical stress testing, and anamnesis.

Main Results:

• Latent SUI identified in 5% of patients; most did not undergo incontinence surgery and remained continent postoperatively.
• De novo SUI occurred in 2.3% of patients.
• Preoperative UD showed low sensitivity (0-44.4%) but moderate specificity (73.8-77.3%) for predicting postoperative SUI, with high negative predictive values.

Conclusions:

• Preoperative UD testing has limited predictive value for postoperative SUI in women undergoing POP surgery.
• Identifying and managing latent SUI preoperatively remains a challenge.
• Further research may be needed to refine UD's role in predicting SUI after POP repair.