title: Can de novo stress incontinence after anterior wall repair be predicted?
abstract: OBJECTIVE
  To locate preoperatively continent women with pelvic organ prolapse at risk of developing incontinence after surgery by means of reducing the prolapse preoperatively with a speculum and a pessary.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Departments of Obstetrics and Gynecology at Northern Alvborgs County Hospital, Varbergs Hospital, and Sahlgrenska University Hospital, Sweden, between 2000 and 2004.
  
  
  METHODS
  Patients scheduled for anterior wall repair with no history of incontinence.
  
  
  METHODS
  Data were collected using a questionnaire, a voiding diary, a gynecological examination including staging of prolapse with the Pelvic Organ Quantification System and clinical testing preoperatively and one year after vaginal repair. The first test included a cough test while the prolapse was reduced with a speculum. The second test was performed with the patient undergoing a standardized quantification test and a 48-hour pad test after reducing the prolapse with a pessary. Postoperatively, clinical testing was repeated one year after surgery without any device in place.
  
  
  METHODS
  Reported symptoms of leakage during movement or coughing.
  
  
  RESULTS
  Seventy-four patients were included. Before surgery, six (8.1%) women tested positive during the speculum test and seven (9.5%) during the pessary test. Eight women (10.8%) were found to have subjective urinary stress incontinence after 1 year. This was only confirmed in four women during stress testing. The positive predictive values for subjective stress incontinence of the speculum and the pessary tests were 42.9% (95%CI 12.0-76.9) and 33.3% (95%CI -4.4 to +71.5), respectively. The negative predictive values of the tests were 92.5% (95%CI 90.3-1.00) and 91.1% (95%CI 88.5-99.7).
  
  
  CONCLUSIONS
  The tested preoperative methods predicting de novo subjective stress incontinence after anterior wall repair did not show sufficient positive predictive values to be clinically useful.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden. m.e.engh@medisin.uio.no
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Ellström Engh
authors.forename: Ann
authors.initials: A
authors.lastname: Ekeryd
authors.forename: Asa
authors.initials: A
authors.lastname: Magnusson
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Olsson
authors.forename: Lena
authors.initials: L
authors.lastname: Otterlind
authors.forename: Gun
authors.initials: G
authors.lastname: Tobiasson
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D058869:Gynecological Examination / Q000295:instrumentation*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010570:Pessaries; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013525:Surgical Instruments; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis*