A 55-year-old woman undergoes anterior colporrhaphy for cystocele. Postoperatively, she complains of new-onset stress urinary incontinence that was not present preoperatively. The most likely mechanism is:

• A Bladder overactivity
• B Urethral hypermobility unmasked after reducing the cystocele ✓
• C Urethral stricture
• D Vesicovaginal fistula

Explanation

B large cystocele can kink and externally compress the urethra, masking underlying stress urinary incontinence. When the cystocele is reduced during anterior colporrhaphy, this compensatory mechanism is lost, unmasking latent SUI. This is why urodynamic assessment is recommended before prolapse surgery. B fistula would cause continuous leakage, not stress-related leakage.

Reference: TeLinde's Operative Gynecology, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.