To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods.
This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction.
The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854).
UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.
World journal of urology. 2018 Jun 05 [Epub ahead of print]
Susane Mei Hwang, Luís Gustavo Morato de Toledo, Silvia da Silva Carramão, Armando Brites Frade, Andre Costa Matos, Antonio Pedro Flores Auge
Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil. ., Department of Surgery, Urology Service, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, SP, Brazil., Department of Obstetrics and Gynecology, Urogynecology Service, Santa Casa de Sao Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61, São Paulo, SP, 01221-020, Brazil., Department of Surgery, Urology Service, Hospital São Rafael, Salvador, BA, Brazil.