Comparison of various modalities to diagnose occult stress urinary incontinence in pelvic organ prolapse

Background: Approximately a quarter of continent women with Pelvic organ Prolapse (POP) may develop Stress urinary incontinence (SUI) on prolapse reduction which is known as Occult SUI (OSUI). Aim of the study was to evaluate the incidence OSUI in women with pelvic organ prolapse (POP). To compare the diagnostic value of ambulatory ring pessary trial, urodynamics and clinical examination in detecting occult stress urinary incontinence and to find out an association of OSUI with demographic profile and the stages of POP. Methods: It was a prospective cohort study conducted between September 2017 to June 2019 in the department of obstetrics and gynaecology, AIIMS, New Delhi. The study was approved by Institutional Ethics Committee. Ref no. IECPG-201/23.08.2017, RT-05/07.09.2017. Results: The incidence of OSUI in this study was 22.8%. It was observed that OSUI is more prevalent in patients with parity of >/=3. Association with factors like age, BMI, mode of delivery and place of delivery was not found to be significant. Among screening tests to diagnose OSUI, ring pessary detected 88.88%, clinical examination and urodynamics (UDS) detected 77.77% and 33.33% cases respectively. The sensitivity of the pessary test, speculum test and UDS were found to be 88.89%, 77.78%, and 33.33% respectively and the diagnostic accuracy of these tests was 97.47%, 94.94% and 84.81% respectively. Conclusions: The pessary was found to detect the maximum number of cases pre-operatively as compared to Urodynamic study and clinical examination.