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Occult Stress Urinary Incontinence in Women With Pelvic Organ Prolapse

Is the One Step Surgical Approach a Risky Choice?

Zacharakis, Dimitrios MD*; Grigoriadis, Themos MD*; Kastanias, Stamatis MD*; Giannoulis, Georgios MD*; Salvatore, Stefano MD; Athanasiou, Stavros MD*

Female Pelvic Medicine & Reconstructive Surgery: January/February 2016 - Volume 22 - Issue 1 - p 55–59
doi: 10.1097/SPV.0000000000000226
Original Articles

Objectives Occult stress urinary incontinence (SUI, OSUI) is defined as the demonstration of SUI after pelvic organ prolapse (POP) reduction. The aim of this study was to evaluate the effectiveness and complication rates of the 1-step surgical approach for treating women with POP and OSUI.

Methods Retrospective study of women with POP and OSUI who underwent a concomitant prolapse and midurethral sling procedure was conducted. Main outcome measures were absence of postoperative urodynamic stress incontinence (USI) and absence of postoperative SUI at 12 months. Secondary outcome measures included evaluation of objective and subjective parameters related to the lower urinary tract function and assessment of the quality of life.

Results Of the 244 women, 205 women (84%) attended the 12-month postoperative follow-up visit and were included in the study. Overall, 87.8% (180/205) of the patients had absence of postoperative urodynamic stress incontinence, whereas 95.1% (195/205) did not report postoperative SUI. Evaluation of parameters related to the postoperative lower urinary tract dysfunction showed that (a) 43% of women with preexisting urgency symptoms continued to have urgency, (b) 16.7% of patients presented de novo urgency, (c) de novo detrusor overactivity occurred in 9.3% of patients, and (d) 4.9% of women with preoperative obstructive voiding symptoms continued to have obstructive voiding symptoms after combined surgery. King's Health Questionnaire data analysis showed a statistically significant improvement in all domains.

Conclusions This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.

In women with prolapse and occult stress urinary incontinence, placement of midurethral sling during prolapse repair was found to be both safe and effective.

From the *First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” Hospital, Athens, Greece; and †Obstetrics and Gynaecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy.

Reprints: Dimitrios Zacharakis, MD, First Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 80 Vas.Sofias Aven, 11528, Athens, Greece. E-mail:

The authors have declared they have no conflicts of interest.

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