MP10-11 WHAT IS THE ROLE OF PREOPERATIVE URODYNAMICS FOR WOMEN UNDERGOING PROLAPSE SURGERY?

Abstract

“kink”, but may unmask stress incontinence (SUI). The association between the severity of cystocele and developing de-novo SUI after prolapse repair however, is poorly understood. We hypothesized that in women undergoing prolapse repair, increasing degrees of bladder prolapse would be associated with increasing rates of post-operative de-novo SUI. METHODS: We performed a secondary analysis of the Colpopexy and Urinary Reduction Efforts (CARE) trial data. Using the control arm (women undergoing prolapse repair without a prophylactic SUI procedure), we identified de-novoSUI using a composite definition based onoriginal trial criteria, including1) newsymptomsofSUI, 2) newphysical exam findings of SUI and 3) any treatment for SUI within one year of prolapse repair. We performed logistic regression to evaluate the relationship between the degree of cystocele and the development of new SUI. RESULTS: Of the 168 women who underwent abdominal sacrocolpopexy alone, 53% developed de-novo post-operative SUI. Stratifying by the degree of anterior prolapse (point Ba), we found a linear increase in the rate of SUI with worsening preoperative cystocele. The incidence of de-novo SUI based on tertile of anterior prolapse from least to most severe, was 41.7%, 53.3% and 63.3%, respectively (Table 1). Point Ba was found to be significant for predicting de-novo SUI on both univariate (OR1⁄41.17 3, p-value 0.015), and multivariate analysis (OR1⁄41.16, p-value 0.04). CONCLUSIONS: The incidence of de-novo SUI after prolapse repair directly correlates to the degree of cystocele on preoperative exam. This simple yet novel relationship should further guide discussions about potential post-operative incontinence with women undergoing prolapse repair.