Table 8.
Diagnostic accuracy of occult stress urinary incontinence for de novo stress urinary incontinence after pelvic organ prolapse surgery without concomitant anti-incontinence surgery
| Reference | Type of POP surgery | Study design | Follow-up (months) | Baseline continence | n a | Test for OSUI | Definition of de novo SUI | Rate of de novo SUI | Sensitivity, % | Specificity, % | PPV, % | NPV, % | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Test positive, n (%) | Test negative, n (%) | ||||||||||||
| Alas et al. [67] | Any | Retrospective | Median 53 | No subjective (nonvalidated) or objective SUI (stress test, UDS) | 210 | UDS up to capacity; reduction with speculum | Subjective (nonvalidated) or objective SUI (not specified) | N/A | 12/210 (4) | N/A | N/A | N/A | 94 |
| Araki et al. [50] | TVM | Retrospective | 6 | No subjective SUI (ICIQ-UI + pad usage) | 62 | CST at 300 ml; reduction with gauze pack or pessary | SUI symptoms + pad usage | 8/13 (62) | 2/49 (4) | 80 | 90 | 62 | 96 |
| Need for SUI surgery | 3/13 (23) | 0/49 (0) | 100 | 83 | 23 | 100 | |||||||
| Ballert et al. [75] | Any vaginal | Retrospective | Mean 17 | No subjective (nonvalidated) or objective SUI (UDS) | 24 | UDS up to capacity; reduction with pessary or vaginal pack | Need for intervention for SUI | N/A | 2/24 (8) | N/A | N/A | N/A | 92 |
| Costantini et al. [76] | SCP | RCT | 6 | No subjective (UDI) or objective SUI (stress test, UDS) | 32 | Stress test with full bladder; reduction both with fingers and speculum | Subjective (UDI) + objective SUI (stress test) | N/A | 3/32 (9) | N/A | N/A | N/A | 91 |
| Ellström Engh et al. [77] | Vaginal NTR | Prospective | 12 | No subjective (nonvalidated) or objective SUI | 74 | CST at 300 ml; reduction with speculum | Subjective SUI (nonvalidated) | 3/7 (43) | 5/67 (7) | 38 | 94 | 43 | 93 |
| Quantification test and 48-h pad test; reduction with pessary | Subjective SUI (nonvalidated) | 2/6 (33) | 6/68 (9) | 25 | 94 | 33 | 91 | ||||||
| Ennemoser et al. [78] | Any vaginal | Retrospective | Mean 68 | No objective SUI (CST) | 57 | Stress test at 300 ml sitting and standing; reduction with speculum | Subjective (nonvalidated) and/or objective and/or treatment for SUI | 16/57 (28) | N/A | N/A | N/A | 28 | N/A |
| Need for SUI surgery | 3/57 (5) | N/A | N/A | N/A | 5 | N/A | |||||||
| Goessens et al. [79] | Vaginal NTR | Retrospective | 2 | No bothersome subjective SUI (nonvalidated) | 132 | Subjective SUI (nonvalidated) revealed during ring pessary home test | Bothersome subjective SUI (nonvalidated) warranting treatment | N/A | 12/132 (9) | N/A | N/A | N/A | 91 |
| Hafidh et al. [80] | Vaginal NTR | Retrospective | 12 | No subjective (nonvalidated) or objective SUI (UDS) | 52 | UDS; reduction with pessary/sponge stick | Subjective SUI warranting any treatment | N/A | 2/52 (4) | N/A | N/A | N/A | 96 |
| Karateke et al. [81] | Vaginal NTR | Retrospective | 20 | No subjective SUI (UDI-6) | 54 | UDS up to 200 ml; reduction with two ring forceps bilaterally | Objective SUI (UDS) | N/A | 8/54 (15) | N/A | N/A | N/A | 85 |
| Kleeman et al. [82] | Vaginal NTR | Retrospective | Mean 5 | No subjective SUI (UDI) | 53 | CST, retrograde filling to subjectively full bladder; reduction with speculum | Subjective SUI (not specified) | N/A | 1/53 (2) | N/A | N/A | N/A | 98 |
| Klutke and Ramos [83] | Vaginal NTR | Retrospective | Mean 42 | No subjective SUI (nonvalidated) | 20 | UDS up to capacity; reduction with Gellhorn pessary | Subjective (nonvalidated) and objective SUI (UDS) | N/A | 0/20 (0) | N/A | N/A | N/A | 100 |
| Liang et al. [84] | Vaginal NTR | Prospective | 3–6 | No subjective SUI (nonvalidated) | 47 | UDS up to capacity; reduction with pessary | Subjective SUI (nonvalidated) | 11/17 (65) | 0/30 (0) | 100 | 83 | 65 | 100 |
| Manodoro et al. [85] | Vaginal NTR | Retrospective | Mean 18 | No subjective SUI (nonvalidated) | 120 | UDS up to capacity; reduction with ring pessary | Objective SUI (CST) or need for SUI surgery | 10/43 (23) | 15/77 (19) | 40 | 65 | 23 | 81 |
| Need for SUI surgery | 0/43 (0) | 0/77 (0) | N/A | 64 | 0 | 100 | |||||||
| Misraï et al. [86] | SCP | Retrospective | Mean 20 | No subjective (nonvalidated) or objective SUI (UDS) | 53 | UDS; reduction with sponge-holding forceps | Objective SUI (not specified) + pad usage | N/A | 7/53 (13) | N/A | N/A | N/A | 87 |
| Reena et al. [87] | Vaginal NTR | Prospective | 1.5 | No subjective (nonvalidated) or objective SUI (not specified) | 78 | Pyridium pad test; reduction with ring pessary | Objective SUI (not specified) | 34/53 (64) | 0/25 (0) | 100 | 57 | 64 | 100 |
| Schierlitz et al. [88] | Vaginal NTR or SCP | RCT | 6 | No subjective SUI (nonvalidated) | 39 | UDS up to capacity; stress test with or without reduction; reduction with speculum or opened forceps | Need for SUI surgery | 3/39 (8) | N/A | N/A | N/A | 8 | N/A |
| Sierra et al. [89] | Any including anterior/apical compartment | Retrospective | 6 | No objective SUI on clinical examination | 97 | UDS up to capacity; reduction with ring pessary, speculum, or scopette | Subjective SUI (nonvalidated) | N/A | 2/97 (2) | N/A | N/A | N/A | 98 |
| Song et al. [90] | Vaginal NTR | Prospective | 6 | No subjective (nonvalidated) or objective SUI (CST) | 206 | Stress test with full bladder and 1-h pad test; reduction with ring pessary | Subjective SUI (UDI-6, IIQ-7) | 18/45 (40) | 30/161 (19) | 38 | 83 | 40 | 81 |
| Need for SUI surgery | 10/45 (22) | 3/161 (2) | 77 | 82 | 22 | 98 | |||||||
| Srikrishna et al. [91] | Not specified | Prospective | 24 | No objective SUI (video-urodynamics) | 48 | Video-urodynamics up to capacity; reduction with ring pessary | Subjective SUI (KHQ) confirmed with video-urodynamics | 2/5 (40) | 1/43 (2) | 67 | 93 | 40 | 98 |
| Svenningsen et al. [92] | Any | Prospective | Mean 5 | No subjective (not specified) or objective SUI (CST) | 137 | Manual reduction at 100ml | Subjective SUI (validated) | (40) | (16) | 9 | 97 | 40 | 84 |
| 135 | Pessary reduction at 100 ml | (22) | (17) | 9 | 94 | 22 | 83 | ||||||
| 107 | Pessary reduction at 300 ml | (50) | (13) | 28 | 94 | 50 | 87 | ||||||
| 79 | Pessary 1 week | (47) | (11) | 50 | 88 | 47 | 89 | ||||||
| 74 | Any of the above positive | (39) | (9) | 73 | 71 | 39 | 91 | ||||||
| Van der Ploeg et al. [93] | Any vaginal | RCT | 12 | Subjective SUI maximum once/week and no objective SUI (CST with full bladder) | 182 | Office evaluation stress test (subjectively full bladder) or urodynamics (up to maximum capacity); reduction with swab | Bothersome SUI (UDI), objective SUI (CST at 300 ml) and/or any treatment for SUI | 18/47 (38) | 11/135 (8) | 62 | 81 | 38 | 92 |
| Van der Ploeg et al. [94] | Any vaginal | RCT | 12 | Subjective UI maximum once/week and no bothersome UI (UDI) | 172 | Office evaluation stress test (subjectively full bladder); with or without reduction; reduction with swab on forceps | Bothersome SUI (UDI) and/or any treatment for SUI | 9/32 (28) | 7/140 (5) | 56 | 85 | 28 | 95 |
| 77 | UDS up to capacity; with or without reduction; reduction with swab on forceps | 3/22 (14) | 4/55 (7) | 43 | 73 | 14 | 93 | ||||||
| Visco et al. [95] | SCP | RCT | 3 | Subjective SUI never or rarely (Medical, Epidemiological, and Social Aspects of Aging questionnaire) | 48 | UDS 300 ml; reduction with ring pessary with support | Subjective SUI (PFDI), objective SUI (stress test at 300 ml) and/or any treatment for SUI | 1/2 (50) | 19/46 (41) | 5 | 96 | 50 | 59 |
| 61 | UDS 300 ml; manual reduction | 4/8 (50) | 18/53 (34) | 18 | 90 | 50 | 66 | ||||||
| 77 | UDS 300 ml; reduction with swab | 11/14 (79) | 22/63 (35) | 33 | 93 | 79 | 65 | ||||||
| 49 | UDS 300 ml; reduction with forceps | 4/8 (50) | 20/41 (49) | 17 | 84 | 50 | 51 | ||||||
| 62 | UDS 300 ml; reduction with speculum | 11/20 (55) | 17/42 (40) | 39 | 74 | 55 | 60 | ||||||
| 297b | All methods | 31/52 (60) | 96/245 (39) | 24 | 88 | 60 | 61 | ||||||
| Wei et al. [96] | Any vaginal | RCT | 3 | No subjective SUI (PFDI) | 170 | Stress test at 300 ml; reduction with swab | Stress, urgency, or mixed UI defined as a positive CST, bothersome symptoms, and/or treatment for UI | 41/57 (72) | 43/113 (38) | 49 | 81 | 72 | 62 |
| Yamada et al. [97] | Anterior colporrhaphy | Retrospective | Mean 58 | No subjective (nonvalidated) or objective SUI | 10 | 1-h pad test and stress test; reduction with ring pessary or vaginal pack | Subjective SUI (nonvalidated) | N/A | 0/10 (0) | N/A | N/A | N/A | 100 |
Diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value) of occult stress urinary incontinence for de novo stress urinary incontinence is shown. Some of the original studies reported diagnostic accuracy values; some studies provided rates of de novo SUI after positive and/or negative test, and diagnostic accuracy values were calculated based on these data
POP pelvic organ prolapse, OSUI occult stress urinary incontinence, SUI stress urinary incontinence, PPV positive predictive value, NPV negative predictive value, UDS urodynamic study, N/A not applicable, TVM transvaginal mesh, CST cough stress test, SCP sacrocolpopexy, RCT randomized controlled trial, NTR native tissue repair, UI urinary incontinence, ICIQ-UI International Consultation on Incontinence Questionnaire–Urinary Incontinence, UDI Urinary Distress Inventory, UDI-6 Urinary Distress Inventory Short Form, IIQ-7 Incontinence Impact Questionnaire Short Form, KHQ King's Health Questionnaire
aOnly women without concomitant anti-incontinence surgery were included
bTotal number of women 165; each subject underwent two different prolapse reduction methods