A 65-year-old woman with stage III uterine prolapse denies any urinary leakage. Urodynamic testing before planned vaginal hysterectomy reveals latent stress incontinence demonstrable only after reduction of the prolapse with a ring pessary. What does this finding predict?

• A Resolution of all urinary symptoms after prolapse surgery
• B Unmasking of stress urinary incontinence after surgical correction of the prolapse ✓
• C Development of detrusor overactivity within one year of surgery
• D Higher risk of vesicovaginal fistula during hysterectomy

Explanation

Kinking of the urethra behind the prolapsed anterior vaginal wall can mask genuine stress incontinence. When the prolapse is reduced, either manually or with a pessary, and leakage appears on coughing or Valsalva, this is occult or latent stress incontinence. It predicts new-onset stress incontinence after prolapse repair because the previously kinked urethra becomes exposed once anatomy is restored. This is why many surgeons offer a concurrent mid-urethral sling or counsel the patient preoperatively.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.