Urinary symptoms are common in women presented with pelvic organ prolapse (POP). Women may consider concomitant surgery for POP and stress incontinence. This study evaluates the urinary incontinence symptoms and the diagnoses in women with advanced stage of pelvic organ prolapse.

This is a retrospective study on women who received transvaginal mesh surgery for stage III/IV POP. Ethic approval has been sought from local institution, informed consent was waived. Women were explored for urinary symptoms, such as stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and voiding symptoms, during their first consultation. Transvaginal mesh surgery was considered for women who had stage III/IV POP, aged 65 years or above and sexually inactive. They were arranged a standard pressure-flow study and voiding cystometry while the prolapse was reduced with vaginal pessary to evaluate the cause of their urinary incontinence and symptoms before the operation.

A total of 183 women, mean age of 71.8 ± 8.4 years, were included. Their median vaginal parity was 3 (interquartile range 2-5). While 57 (31.1%) had no urinary incontinence, 32 (17.5%), 22 (12%) and 72 (39.3%) reported symptoms of SUI alone, UUI alone and mixed urinary incontinence. Besides, 80 (43.7%) of them reported voiding symptoms, such as need of manual reduction for voiding, slow stream or sense of incomplete emptying. Four women (2 had no urinary incontinence, 1 UUI and 1 mixed UI) did not receive urodynamic study before operation. For the remaining, 102 (30.7%), 56 (17.9%), 12 (12.3%) and 9 (40.2%) had normal study, urodynamic stress incontinence (USI), detrusor overactivity (DO) and concomitant USI and DO (mixed USI and DO) (Table 1). 

Occult USI, DO and mixed USI and DO occurred in 9.1%, 1.8% and 1.8% of the women who did not report any symptoms of UI, respectively. In the group who reported SUI alone, only 50% were diagnosed USI; 12.6% had DO or mixed USI and DO. Of those reported UUI alone, 23.8% had USI. Finally, among those who reported mixed UI, 42.3% had USI.

Occult USI was found in 9.1% of women without symptoms of UI. However, they might be benefit from continence surgery. In the three groups of women who reported symptoms of UI, 43.5% (51/124) had normal findings in urodynamic study whom might not need continence surgery, and 5.3% (19.124) had DO or mixed USI and DO whom might have worsening of urinary symptoms after continence surgery.

Urodynamic study is an important investigation to guide the management of women on the option of concomitant continence surgery during POP repair.