Can de novo stress incontinence after anterior wall repair be predicted?

Abstract

Objective: To locate preoperatively continent women with pelvic organ prolapse at risk of developing incontinence after surgery by means of reducing the prolapse preoperatively with a speculum and a pessary.

Design: Prospective observational cohort study.

Setting: Departments of Obstetrics and Gynecology at Northern Alvborgs County Hospital, Varbergs Hospital, and Sahlgrenska University Hospital, Sweden, between 2000 and 2004.

Population: Patients scheduled for anterior wall repair with no history of incontinence.

Methods: Data were collected using a questionnaire, a voiding diary, a gynecological examination including staging of prolapse with the Pelvic Organ Quantification System and clinical testing preoperatively and one year after vaginal repair. The first test included a cough test while the prolapse was reduced with a speculum. The second test was performed with the patient undergoing a standardized quantification test and a 48-hour pad test after reducing the prolapse with a pessary. Postoperatively, clinical testing was repeated one year after surgery without any device in place.

Main outcome measures: Reported symptoms of leakage during movement or coughing.

Results: Seventy-four patients were included. Before surgery, six (8.1%) women tested positive during the speculum test and seven (9.5%) during the pessary test. Eight women (10.8%) were found to have subjective urinary stress incontinence after 1 year. This was only confirmed in four women during stress testing. The positive predictive values for subjective stress incontinence of the speculum and the pessary tests were 42.9% (95%CI 12.0-76.9) and 33.3% (95%CI -4.4 to +71.5), respectively. The negative predictive values of the tests were 92.5% (95%CI 90.3-1.00) and 91.1% (95%CI 88.5-99.7).

Conclusions: The tested preoperative methods predicting de novo subjective stress incontinence after anterior wall repair did not show sufficient positive predictive values to be clinically useful.