title: Utilizing preoperative 20-minute pad testing with vaginal gauze packing for indicating concomitant midurethral sling during cystocele repair.
abstract: OBJECTIVE
  To investigate the feasibility of using preoperative 20-minute pad testing with vaginal gauze packing for cystocele reduction to indicate a concomitant midurethral sling during cystocele repair.
  
  
  METHODS
  Retrospective review of the records of consecutive women with pelvic organ prolapse quantification≥stage II symptomatic cystocele who visited the urogynecologic outpatient clinics and underwent cystocele repair between July 2005 and December 2010. Only patients who underwent preoperative urodynamic studies and 20-minute pad testing with vaginal gauze packing for cystocele reduction were enrolled.
  
  
  RESULTS
  Twenty-one patients did not demonstrate any stress urinary incontinence. For evident stress urinary incontinence (>1g pad weight before reduction), the criterion of ≥8g pad weight before reduction was chosen for concomitant midurethral sling. For patients with occult stress urinary incontinence (≤1g pad weight before reduction), the criterion of ≥8g pad weight after reduction was chosen as an indication for concomitant midurethral sling. Among 22 patients with evident stress urinary incontinence (<8g) without concomitant midurethral sling, only one patient (4.5%) received a midurethral sling during the follow-up period (median follow-up interval: 30.5 months). Among 21 patients with occult stress incontinence but <8g after reduction without concomitant midurethral sling, only one patient (4.8%) received midurethral sling during the follow-up period (median follow-up interval: 38 months).
  
  
  CONCLUSIONS
  A preoperative 20-minute pad test with vaginal gauze packing for cystocele reduction is a feasible and practical method to decide for a concomitant midurethral sling.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ting-Chen
authors.initials: TC
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors.forename: Sheng-Mou
authors.initials: SM
authors.lastname: Hsiao
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chi-Hau
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors.forename: Wen-Yih
authors.initials: WY
authors.lastname: Wu
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hhlin@ntuh.gov.tw.
authors.forename: Ho-Hsiung
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000368:Aged; D052858:Cystocele / Q000150:complications / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000175:diagnosis* / Q000601:surgery
keywords: Cystocele; Midurethral sling; Pad test; Pelvic organ prolapse; Stress urinary incontinence