title: Need for sling surgery in patients with large cystoceles and masked stress urinary incontinence.
abstract: BACKGROUND
  We studied the need for sling surgery in patients who suffered from large cystoceles and masked stress urinary incontinence.
  
  
  METHODS
  Twenty patients who had large cystoceles but neither evidence nor history of stress incontinence were enrolled in this study. The cystocele was reduced using a reducing device. Masked urinary incontinence was identified by a 60 m pad weighing test and a stress test. The cystocele was reduced using a pessary ring in 14 patients, or a vaginal pack formed of two rolls of ordinary 28 x 28 cm gauze in six patients. Ten of 20 patients were diagnosed with masked stress urinary incontinence and were treated with anterior colporrhaphy and a suburethral sling procedure. The other 10 patients were continent after use of a cystocele reducing device and were treated with anterior colporrhaphy alone. Average follow-up periods of the patients with or without masked stress urinary incontinence were 51.2 months (range, 24.0-72.0 months) or 57.6 months (range, 27.0-70.0 months), respectively.
  
  
  RESULTS
  One of the 10 patients diagnosed with masked stress incontinence had mild stress urinary incontinence postoperatively. None of the 10 continent patients had stress incontinence after anterior colporrhaphy alone.
  
  
  CONCLUSIONS
  Reducing devices of protruding cystocele were clinically useful in the detection of masked stress incontinence. Sling surgery was effective to prevent emerging stress urinary incontinence for patients who suffered from cystocele and masked stress incontinence.
authors.affiliation: Department of Urology, Saitama Medical Center, Saitama Medical School and Department of Urology, Kasukabe Municipal Hospital, Saitama, Japan. t_yamada@saitama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: N
authors.initials: N
authors.lastname: Ichiyanagi
authors.forename: S
authors.initials: S
authors.lastname: Kamata
authors.forename: Y
authors.initials: Y
authors.lastname: Sakai
authors.forename: K
authors.initials: K
authors.lastname: Nagahama
authors.forename: A
authors.initials: A
authors.lastname: Tanizawa
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Horiuchi
authors.forename: H
authors.initials: H
authors.lastname: Saitoh
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation