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The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study

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Abstract

Purpose

Part of the patients with pelvic organ prolapse but without symptoms of stress urinary incontinence (SUI) may demonstrate SUI after prolapse surgery (occult SUI), and no optimal preoperative screening method is currently available for it. The aim of this study was to estimate the value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling (MUS) following prolapse surgery.

Methods

Two hundred and six patients were enrolled for advanced prolapse without complaining of urinary incontinence (UI) in this prospective cohort study. Exclusion criteria included prior or concomitant anti-incontinence surgery. Preoperatively, a stress test, the 1-h pad test and uroflowmetry were performed with prolapse reduction. Primary outcome was postoperative de novo UI. Median follow-up was 31 months (range 12–48 months).

Results

Of the 206 patients, 45 (21.8 %) had evidence of occult SUI preoperatively, 62 (30.1 %) exhibited de novo UI postoperatively, and only 13 (6.3 %) opted MUSs. Patients with occult SUI experienced higher de novo UI rate (53.3 vs. 23.6 %; P = 0.000). The OSUI and concomitant hysterectomy were identified as independent risk factors related to de novo UI (P = 0.000, P = 0.044). We performed receiver operating characteristic (ROC) curve analysis to evaluate the value of preoperative 1-h pad test. The area under ROC curve was 0.816 ± 0.085 (95 % CI 0.649–0.983); the cutoff value was 1.9 g (sensitivity 80.0 %, specificity 83.9 %).

Conclusions

The preoperative 1-h pad test with prolapse reduction is feasible for screening occult SUI, and more than 1.9 g may be a practical indicator of a postoperative subsequent MUS.

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Acknowledgments

We are indebted to Dr. Tao Xu, who was consulted from the Department of Statistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, for help in the statistical analyses.

Conflict of interest

All authors declare that they have no conflicts of interest regarding a financial relationship with the organization that sponsored the research.

Ethical standard

This study has been approved by the Institutional review board ethics committee and has therefore been performed in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments. All persons provided their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People’s Republic of China

    Xiaochen Song, Lan Zhu & Jing Ding

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  1. Xiaochen Song
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  2. Lan Zhu
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  3. Jing Ding
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Correspondence to Lan Zhu.

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Song, X., Zhu, L. & Ding, J. The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study. World J Urol 34, 361–367 (2016). https://doi.org/10.1007/s00345-015-1590-8

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  • DOI: https://doi.org/10.1007/s00345-015-1590-8

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