title: Mixed incontinence and cystocele: postoperative urge symptoms are not predicted by preoperative urodynamics.
abstract: 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.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232-2765, USA. wolter.christopher@mayo.edu
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Wolter
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: John W
authors.initials: JW
authors.lastname: Duffy
authors.forename: Harriette M
authors.initials: HM
authors.lastname: Scarpero
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
mesh_terms: 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*