title: Videourodynamic diagnosis of occult genuine stress incontinence in patients with anterior vaginal wall relaxation.
abstract: OBJECTIVE
  To (1) utilize videourodynamics, the gold standard, to assess the prevalence of occult genuine stress incontinence (GSI) among preoperative patients with symptomatic anterior vaginal wall relaxation and (2) identify urodynamic discriminators that might help predict occult GSI.
  
  
  METHODS
  In this prospective study, videourodynamic evaluation was performed on 48 consecutive patients presenting for preoperative urodynamic evaluation of anterior vaginal wall prolapse. Patients with occult GSI were identified by urodynamic testing with and without Gehrung pessary support of the bladder base during stress maneuvers. Variables from the history, physical examination, and videourodynamics were then analyzed.
  
  
  RESULTS
  The overall incidence of occult GSI was 25% (22.7% in the pelvic organ prolapse [POP] group and 26.9% in the POP-UI group). Patients with occult GSI were not identifiable on history but did have a higher incidence of late first sensation, open bladder neck at rest, and hypermobility on imaging with videourodynamics.
  
  
  CONCLUSIONS
  This study suggests that one quarter of women presenting with anterior wall relaxation with or without incontinence symptoms have occult GSI. Given this high prevalence, preoperative evaluation with urodynamics, possibly videourodynamics, utilizing bladder base support is justified if the data are substantiated in a larger, definitive study. Patients with a late first sensation, open bladder neck, and hypermobility may have a higher incidence of occult GSI.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA.
authors.forename: E
authors.initials: E
authors.lastname: Versi
authors.forename: D J
authors.initials: DJ
authors.lastname: Lyell
authors.forename: D J
authors.initials: DJ
authors.lastname: Griffiths
mesh_terms: D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D011446:Prospective Studies; D001745:Urinary Bladder Diseases; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014563:Urodynamics; D014596:Uterine Prolapse / Q000150:complications*; D014741:Video Recording