Relevancia clínica del estudio urodinámico en el tratamiento de la incontinencia urinaria oculta asociada al prolapso de órganos pélvicos

Abstract

Clinical relevance of the urodynamic study during treatment of occult urinary incontinence associated with prolapse of pelvic organs The general aim of this study is to evaluate the usefulness of performing the urodynamic study as part of the pre-operative protocol for pelvic organ prolapse (POP). The inclusion of urodynamics in the surgical POP study is moot and although the International Continence Society (ICS) recommends this, its diagnostic value is not fully elucidated 1 . However, when combined prolapse and incontinence surgery is to be performed, this enables defining not only patients with stress urinary incontinence, but also those with occult urinary incontinence in addition to de novo emergency, present in some cases before surgery and not a consequence of them. Material and methods: Retrospective cohort study of women diagnosed with surgical prolapse of pelvic organs regardless of whether or not their clinical history refers symptoms of stress urinary incontinence. An urodynamic study with reduction of the prolapse by means of disposable speculum was performed on them.Material and methods: Retrospective cohort study of women diagnosed with surgical prolapse of pelvic organs regardless of whether or not their clinical history refers symptoms of stress urinary incontinence. An urodynamic study with reduction of the prolapse by means of disposable speculum was performed on them. Results: A total of 94 women were collated; 50 women were diagnosed with stress urinary incontinence, seven with overactive bladder (OAB) and 37 presented normal urodynamics. Occult stress urinary incontinence was diagnosed in 26 women (27.7%); all of them had an incontinence correction technique associated with the prolapse surgery. After combined surgery for both processes, only two patients (7.7%) presented de novo emergency. Conclusions: Occult stress urinary incontinence commonly presents symptoms after the prolapse is corrected. In this study, when performing urodynamics pre-operatively, 26 women (27.7%) of the 94 patients were diagnosed with occult urinary incontinence. All of them had the incontinence corrected during the same surgery as the prolapse, and because the hyperactive bladders were diagnosed and treated pre-operatively there were only two cases of postoperative de novo emergencies. Therefore, if the incontinence and prolapse are to be corrected at the same time, the urodynamic study with reduction of pre-operative prolapse enables a better selection of patients by reducing the adverse effects of surgery in this way. .