E-Posters-Eyeball Urodynamics: Is There Value To Predict Hidden (Occult) Stress Urinary Incontinence With Sims Speculum Reduction In Patients With Pelvic Organ Prolapse? - A Retrospective Descriptive Study - Jacobus A van Rensburg, MB BCh, MMed, FCOG(SA)

Eyeball Urodynamics: Is There Value To Predict Hidden (Occult) Stress Urinary Incontinence With Sims Speculum Reduction In Patients With Pelvic Organ Prolapse? - A Retrospective Descriptive Study - Jacobus A van Rensburg, MB BCh, MMed, FCOG(SA)

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This study aimed to determine the value of a Sims speculum reduction test combined with eyeball/office urodynamics (UDS) in predicting occult stress urinary incontinence (OSUI) in women with pelvic organ prolapse (POP) undergoing surgery. The study included 123 women who underwent POP surgery and were evaluated preoperatively with the POP-Q grading system. Routine preoperative UDS was performed using either eyeball or laboratory methods. The Sims speculum reduction test was performed in the sitting position, and patients were categorized as having frank SUI, OSUI, or no OSUI. At 6-week follow-up, postoperative stress urinary incontinence (POSUI) was evaluated.<br /><br />The results showed that among the 17 patients identified with OSUI, 6 underwent combined surgery for POP and stress urinary incontinence (SUI), while 11 underwent POP surgery only. Among the 14 OSUI patients who completed follow-up, POSUI was clinically demonstrated in 2 cases. Overall, the Sims speculum reduction test had a sensitivity of 20%, specificity of 78.12%, positive predictive value of 12.5%, and negative predictive value of 86.21%. There was no significant difference between the eyeball and laboratory UDS methods in predicting OSUI.<br /><br />The study also found that 31.7% of women had postoperative anterior compartment prolapse, and the incidence of POSUI was higher in women with recurrent anterior POP compared to those without. Seven women required reoperation for POP, and 3 women required mid urethral sling (MUS) insertion for bothersome POSUI.<br /><br />The authors concluded that the Sims speculum reduction method with eyeball UDS in a sitting position poorly predicted postoperative OSUI. However, they noted limitations in the study, such as its retrospective design, small sample size, and lack of standardization for the clinical postoperative SUI cough test. They also observed that the protective effect of anterior POP recurrence against POSUI, as reported in another study, was not seen in their study. Therefore, caution should be exercised in making statistical conclusions based on these findings.

Keywords

Sims speculum reduction test

eyeball/office urodynamics

occult stress urinary incontinence

women

pelvic organ prolapse

POP surgery

POP-Q grading system

preoperative UDS

postoperative stress urinary incontinence

anterior compartment prolapse