title: Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up.
abstract: OBJECTIVE
  Patients with genital prolapse and occult stress urinary incontinence (OSUI) are typically treated with prolapse surgery and anti-incontinence surgery based on either a one-step approach or a two-step approach. The aim of our study was to determine whether anti-incontinence surgery is necessary based on the occurrence of OSUI in a study cohort with a long follow-up period.
  
  
  METHODS
  Prolapse surgery was performed using a vaginal approach. Preoperatively, a stress test, a pad test and an assessment of the urodynamics were performed with and without prolapse reduction. Over a follow-up period of 2-8 years, the patients with preoperative evidence of OSUI underwent urogynaecological examinations, stress tests and pad tests.
  
  
  RESULTS
  Of 113 patients with preoperative evidence of OSUI, 57 (50.4 %) were followed up for an average of 5.7 years (range 2-8) after prolapse surgery. Of 57 patients, 16 (28.1 %) had objective and/or subjective stress urinary incontinence (SUI) during the follow-up period, but only 3 patients (5.3 %) required subsequent tension-free vaginal tape (TVT) surgery. In 17 of 57 patients (29.8 %), prolapse recurred.
  
  
  CONCLUSIONS
  Despite the preoperative evidence of OSUI, the manifestation of SUI rarely occurs, with 28.1 % of patients experiencing SUI over long-term follow-up after vaginal prolapse surgery. Anti-incontinence surgery was necessary in only three cases (5.3 %). These results indicate that with the one-step approach, 54 of 57 patients (94.7 %) would have received prophylactic anti-incontinence surgery unnecessarily. In conclusion, we recommend the two-step approach in the management of vaginal prolapse surgery in patients with OSUI.
authors.affiliation: Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU - Innenstadt, Maistr. 11, 80337 Munich, Germany. stefanie.ennemoser@med.uni-muenchen.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ennemoser
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schönfeld
authors.forename: Vera
authors.initials: V
authors.lastname: von Bodungen
authors.forename: Darius
authors.initials: D
authors.lastname: Dian
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
authors.forename: Katharina
authors.initials: K
authors.lastname: Jundt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*