De Novo Stress Urinary Incontinece After Prolapse Surgery

From continence to incontinence and back again.

A 62-year old patient presented with second degree pelvic organ prolapse. Other than the typical symptoms of significant bladder and uterine descent, she denied being incontinent. The urodynamic studies confirmed this finding and the urethral closure pressure was normal. Interestingly the cough-test after reposition of the prolapse was positive. After thorough explaining of occult urinary incontinence, the patient still wished a two-step approach.

Occult stress urinary incontinence. Left: patient in relaxed position. Right: patient performing Valsalva. While there is some degree of bladder neck descent, the most astounding finding here is the cystocele. The empty bladder vanishes below the pelvis. Green: urethra. Blue: bladder. S: symphysis pubis.

We performed combined vaginal (anterior colporrhaphy) and laparoscopic (bilateral adnexectomy, supracervical hysterectomy and sacrocervicopexy) surgical management of the prolapse.

Want to read more about laparoscopic treatment of apical prolapse? This article offers more detailed information.

After surgery all prolapse symptoms disappeared. Our patient showed up 6 weeks later to our scheduled control examination. She now had de novo stress urinary incontinence.

Urine leakage at Valsalva. Note the disappearance of prolapse.

We discussed with her all possibilities. After an initial try with an injectable failed, we performed a retropubic TVT.

No leakage after succesful TVT placement. Note the TVT as a hyperechogenic line in the bottom of the image behind the urethra.

And just like that the incontinence was lifted.

Want to read more about how to depict stress urinary incontinence in ultrasound? Check this article.

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