Pessary Trial May Detect Occult Stress Urinary Incontinence

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An ambulatory pessary trial is a simple and cost-effective way to predict women's response to surgical repair of anterior vaginal wall prolapse, according to the findings of a small retrospective study.

The study, led by Elise De, MD, of the Urological Institute of Northeast New York in Albany, found that a one-week pessary trial alone identified occult stress urinary incontinence (SUI) in 19% of patients, researchers reported online in Obstetrics and Gynecology International.

Of 26 women who completed a one-week pessary trial, 10 (38.4%) showed no evidence of SUI and underwent surgical repair of prolapse without an anti-incontinence procedure.

None of these patients had SUI after surgery. The other 16 women (61.5%) had occult SUI on evaluation by pessary trial, clinical report, urodynamic testing, or physical exam and underwent a sling procedure concurrent with prolapse repair. Three of these patients (19%) were identified by pessary trial alone. At a mean follow-up of 12 months, 25 of the 26 patients were without clinical stress incontinence.

In addition, the pessary trial correctly predicted persistent urgency in six patients and persistent frequency in five. The pessary trial did not miss any patient with SUI or persistent voiding difficulty.

“This reversible trial aids in the decision to perform anti-incontinence procedures and in setting appropriate postoperative expectations regarding urgency and emptying ability,” the authors concluded.

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