Ringing the changes in evaluation of urogenital prolapse.

Introduction And Hypothesis: Some women with pelvic organ prolapse (POP) have occult urodynamic stress incontinence (OUSI) and might develop incontinence after POP surgery. Our aim was to determine predictive value of ring pessary test during urodynamics in identifying patients with OUSI, likely to develop stress urinary incontinence (SUI) postoperatively.

Methods: Women with POP were recruited from surgical lists. All underwent preoperative videocystourethrography (VCU). Women with normal VCUs had tests repeated after pessary reduction of POP.

Results: One hundred and twelve women were studied. Forty-eight women had "normal" VCU. Of these, 43 had no OUSI and only 1/43 developed SUI postoperatively. Five women had OUSI and 2/5 developed frank SUI. The pessary test had poor sensitivity (67%) but high specificity (93%) in predicting postoperative SUI. Positive predictive value was low (40%), with an excellent negative predictive value (98%).

Conclusion: This test can identify patients likely to remain continent following surgery and be a valuable tool in preoperative counselling.