Mixed incontinence and cystocele: postoperative urge symptoms are not predicted by preoperative urodynamics.
OBJECTIVE
Pelvic organ prolapse (POP) frequently presents with urinary incontinence, either urge (UUI), stress (SUI), or mixed (MUI). We sought to determine the effect of high-grade prolapse repair on MUI.


METHODS
A retrospective review was performed for 111 patients with anterior POP repair and sling over 4 years.


RESULTS
Sixty patients (54%) presented symptomatically with MUI, 25% with SUI, and 9% with UUI, 12% asymptomatic. Occult SUI was found in 21% (UUI plus asymptomatic). Success was seen for SUI in 92% and for POP in 89%. Urge symptoms were present in 63% pre-op and 30% post-op. MUI patients were significantly more likely to experience post-op urgency (p = 0.033). Detrusor overactivity (DO) was seen in 22 MUI patients, but was not predictive of post-op urgency (p = 0.91).


CONCLUSIONS
Cystocele patients with MUI are at significant risk for postoperative urge symptoms regardless of DO, and counseling regarding persistent urgency is imperative.
Wolter
Christopher E
CE
Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232-2765, USA. wolter.christopher@mayo.edu
Kaufman
Melissa R
MR
Duffy
John W
JW
Scarpero
Harriette M
HM
Dmochowski
Roger R
RR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000503:physiopathology* / Q000601:surgery*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000453:epidemiology; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000209:etiology*; D014563:Urodynamics / Q000502:physiology*