Prolapse Pessary Tests

Abstract

Urodynamic testing with and without pessaries or other vaginal supports are necessary to evaluate patients who have genital prolapse and associated urethral hypermobility even if they do not complain of urinary stress incontinence. This is particularly important since the prolapse may protect the patient from stress incontinence by a mechanical kinking effect in the urethra during periods of elevated intra-abdominal pressure from coughing or other activities (Chapter 28). Certain patients may apparently develop stress incontinence following surgical repair of their genital prolapse if sufficient attention is not paid to providing permanent support to the urethro-vesical junction. Urodynamics with a pessary or other vaginal support is designed to simulate, in the urodynamics laboratory, the surgical correc-tion of genital prolapse without resupporting the bladder neck. Urodynamic evaluation of these patients with and without support of their genital prolapse provides information on urethrovesical function which may guide the surgeon in selecting the most appropriate surgical procedure for that particular patient.