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402 - OCULT VERSUS SYMPTOMATIC STRESS URINARY INCONTINENCE IN PELVIC ORGAN PROLAPSE: COMPARATIVE STUDY

402

OCULT VERSUS SYMPTOMATIC STRESSURINARY INCONTINENCE IN PELVIC ORGAN PROLAPSE: COMPARATIVE STUDY

N. MELO 1, J. VASCONCELOSNETO 2, C. VASCONCELOS 3, E. S. BARBOSA 1,A. P. BILHAR 4, S. A. KARBAGE 5, L. S.BEZERRA6, K. L. AUGUSTO 7;
1UROGINECOLOGIA, Hosp. GERAL DE FORTALEZA, Fortaleza,Brazil, 2Hosp. Geral de Fortaleza, Fortaleza, Brazil,3Univ.e Federal do Ceará, Fortaleza, Brazil, 4UNIFESP,Fortaleza, Brazil, 5Univ.e Federal do Cearÿ, Fortaleza -Ceara, Brazil, 6Saúde Materno Infantil, Federal Univ. ofCeara, Fortaleza, Brazil, 7Laparoscopy and Minimallyinvasive surgery, Maternidade Escola Assis Chateaubriand, Fortaleza,Brazil.

Introduction: Urinaryincontinence (UI) is underdiagnosed around the world. It is estimatedthat between 26% and 61% of women seek care, particularly stressurinary incontinence (SUI), often coexists with pelvic organ prolapse(POP). However, up to 80% of women with POPs do not complain of UI.Even patients with intrinsic urethral sphincter deficiency may becontinents, due to the elongation or external compression of theurethra by prolapse 1,2. After correction or reduction ofit, they may become incontinent, constituting the hidden urinaryincontinence. The diagnosis of occult SUI (OSUI) is presence of UI onthe physical examination, or SUI in the urodynamic study (EUD), afterPOP reduction, in women who did not present SUI symptoms3.
Objective: to compare the anatomicalevaluation, quality of life (QoL), sexual function and the urodynamicparameters of patients with symptomatic stress urinary incontinence(SSUI) and OSUI.
Methods: All patients with SUI attended atthe Urogynecology outpatient clinic of a tertiary hospital, from June2011 to June 2016, were evaluated. A structured data collectioninstrument was used, containing sociodemographic data andsymptom-directed anamnesis of pelvic floor dysfunction. Patientsunderwent standardized physical examination (POP-Q), urodynamic andportuguese validated QoL assessment (Short-Form Health Survey- SF-36, Prolapse Quality-of-Life Questionnaire - PQOL andPelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire- PISQ-12). Continent females were diagnosed of OSUI when physicalexamination or EUD revealed, after POP reduction, loss of urineduring exercise. Of the 420 women treated in the period, thecontinent patients were excluded, and those who presented urgeincontinence alone or associated with SUI, leaving a total of 102women. They were divided into two groups: OSUI (n = 32) and SSUI (n =70). Inclusion criteria: POP-Q ≥ II, absence of urinary effort lossin the clinical history and demonstration of OSUI using urodynamicevaluation. Were excluded women with contraindications for pelvicsurgery, urogenital fistula, neurogenic or congenital bladderdisorder, malignancy, or being medically incapable. Data werecompiled and analyzed using the statistical software SPSS 22.0.Interval variables with abnormal distribution were described inmedian and interquartile range (P25-P75); And categorical variables,in frequencies and percentages. The Mann-Whitney test and categoricalvariables, Pearson's chi-square, were used to compare the intervalvariables. Values of p <0.05 were considered significant.
Results:Women with OSUI were older (p = 0.000), Have had more pregnancies (=0.038) and with higher number of vaginal deliveries (= 0.005). Theypresented similar schooling and income. Women with OSUI had morecomplaints of difficulty initiating urination (p = 0.027), but thefeeling of incomplete emptying was similar in both groups.Constipation (p = 0.022) and vaginal looseness (p = 0.004) were morefrequent in the SSUI group, but “vaginal ball sensation” (p =0.002) occurred more in the OSUI. The prolapses of all compartmentswere higher in patients with OSUI (p<0.05). Despite the apparentlymore obstructive pattern of OSUI, there was a higher maximum fluxflow value in SSUI than in OSUI (p>0.008) there was no differencein flow time, or loss pressure between the groups. Changes in SF-36demonstrate a worse overall QoL for women with SSUI (p<0.05), butwhen assessing the impact of prolapse (PQOL) and sexual function(PISQ) on QoL, patients with OSUI showed greater injury.
Conclusions:OSUI is an important diagnosis with peculiar anatomicalcharacteristics, QoL impact, sexual function and urodynamicparameters, when compared with SSUI. A careful evaluation of womenwith bulky POP is therefore important in order to detect those whoare taking OSUI and perform the appropriate treatment in a timelymanner.
References: GORDON, D. et al. Development ofpostoperative urinary stress incontinence in clinically continentpatients undergoing prophylactic Kelly plication during genitourinaryprolapse repair. Neurourol. Urodyn., v. 18, n. 3, p. 193-197,1999.MORRILL, M. et al. Seeking healthcare for pelvic floordisorders: a population-based study. Am. J. Obstet. Gynecol.,v. 197, n. 1, Jul. 2007.HAYLEN, Bernard T. et al. an internationalurogynecological association (IUGA)/international continence society(ICS) joint report on the terminology for female pelvic floordysfunction. Int. Urogynecol. J. Pelvic. Floor Dysfunct., v. 21, n.1, p. 5-26, 2010.

Anatomicalcomparison (POP-Q) of the OSUI and SSUI groups

POP-Q

OSUI(n=32)Md (P25% - P75%)

SSUI(n=70)Md (P25%- P75%)

pvalue

Bapoint

3.0(-1.0 - 5.0)

 -1.0(-2.0 - 0.0)

0.000

Bppoint

0.0(-3.0 - 5.0)

 -2.0(-2.0 - -0.2)

0.009

Cpoint

 -4.0(-6.0 - 6.0)

-7.0(-8.0 - -6.0)

0.000

GenitalHiatus

 5.0(4.0 - 7.0)

4.0(4.0 - 5.0)

0.003

PerinealBody

 3.0(2.0 - 4.0)

 3.0(3.0 - 4.0)

0.006

LargerPOP point stage

3.0(2.0 - 3.0)

2.0(1.0 - 2.0)

0.000