[Inventory and follow-up of patients with surgery for (uterine) vaginal prolapse, combined with or without, (masked) stress incontinence].

OBJECTIVE

Evaluation of the development or persistence of urinary stress incontinence in patients operated on because of prolapsed uterus, with cooperation between gynaecologists and urologists.

DESIGN

Retrospective.

SETTING

Department of Gynaecology and Obstetrics, Leyenburg Hospital, The Hague, the Netherlands.

METHODS

In 178 patients subjected to prolapse correction in the period 1992-1996, presence of urinary incontinence was analysed by means of a written enquiry after an average of 22 months. The 91 patients who had visited the gynaecological outpatient clinic and were seen together with a urologist, were subjected to urodynamic examination in the absence of symptoms of stress incontinence and were operated in cooperation with the urologist. Four groups were distinguished on the basis of preoperative features: group I (n = 37) with manifest stress incontinence, group II (n = 22) with masked stress incontinence, group III (n = 32) in whom no (masked) stress incontinence could be demonstrated and group IV (n = 87) not subjected to urodynamic examination. The patients of groups I and II, in addition to prolapse correction, were also subjected to urethral suspension.

RESULTS

Twenty-five (68%) of the group with manifest stress incontinence were free of stress incontinence after the operation, while eight patients (22%) reported improvement (a total of 89%). In 22 of the 54 patients (41%) who preoperatively had no incontinence symptoms, urodynamic examination revealed a masked stress incontinence. Sixteen of them (73%) did not develop symptoms of stress incontinence after the operation, while eight (15%) did develop such symptoms. Thirty of the 32 patients (94%) who preoperatively had no (masked) stress incontinence remained symptom-free. Out of 64 patients without preoperative incontinence, who were operated without urological cooperation, 12 (19%) developed stress incontinence.