Reevaluating occult incontinence
- 1 October 2005
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Obstetrics and Gynecology
- Vol. 17 (5), 535-540
- https://doi.org/10.1097/01.gco.0000183530.03481.64
Abstract
Occult incontinence is a controversial subject without significant exposure in the literature. Conventionally, it has been assumed to be a marker for increased risk of postoperative stress urinary incontinence (POSUI) after repair of pelvic organ prolapse. The controversy surrounds the performance of prophylactic incontinence procedures based on this assumption. Until 2004 no article in the English language had been published demonstrating an association between occult incontinence and increased risk of stress urinary incontinence after repair of severe pelvic organ prolapse in previously continent women. We will explore the evidence regarding occult incontinence, review the data on intervention trials, and address questions that remain. The limited evidence suggests 11–22% of continent patients with severe pelvic organ prolapse will develop POSUI. New evidence suggests that patients with occult incontinence are at substantially more risk. Since anti-incontinence procedures in patients with occult incontinence reduces the incidence of POSUI (to 0–15%), there appears to be some benefit from screening and intervention. Most studies on the subject are small and limited by their design. Results differ regarding whether a negative stress test can be used to rule out the risk of POSUI. Minimal existing evidence in the English language suggests that patients with occult incontinence are at increased risk of POSUI. Outcomes in occult incontinence patients undergoing repair of pelvic organ prolapse need systematic study. Until there is adequate solid evidence on the predictive values of our screening test, we cannot counsel patients regarding our ability to prevent POSUI or protect them from unnecessary procedures.Keywords
This publication has 28 references indexed in Scilit:
- Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse?International Urogynecology Journal, 1998
- Surgery for genitourinary prolapse and stress incontinence: A randomized trial of posterior pubourethral ligament plication and Pereyra suspensionAmerican Journal of Obstetrics and Gynecology, 1997
- Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapseAmerican Journal of Obstetrics and Gynecology, 1996
- Stress urinary incontinence: Where are we now, where should we go?American Journal of Obstetrics and Gynecology, 1996
- Failure to predict and attempts to explain urinary stress incontinence following vaginal repair in continent women by using a modified lateral urethrocystographyActa Obstetricia et Gynecologica Scandinavica, 1991
- Dynamic Urethral Pressure Profilometry Pressure Transmission Ratio Determinations After Continence SurgeryObstetrics & Gynecology, 1988
- Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapseAmerican Journal of Obstetrics and Gynecology, 1988
- Urethral axis and sphincteric functionAmerican Journal of Obstetrics and Gynecology, 1986
- The effect of uterovaginal prolapse on urethrovesical pressure dynamicsAmerican Journal of Obstetrics and Gynecology, 1983
- Observations on Stress Incontinence of Urine**Presented at the Seventy-fifth Annual Meeting of the American Gynecologial Society, Hot Springs, Va., May 12 to 14, 1952.American Journal of Obstetrics and Gynecology, 1952