Preoperative urodynamics and the risk of overdiagnosis and overtreatment of occult urinary incontinence in continent women with advanced pelvic organ prolapse

PURPOSE: This study aimed to investigate the impact of preoperative urodynamics (UDS) on the surgical treatment of pelvic organ prolapse (POP). It assessed whether UDS provided additional diagnoses, modified surgical planning, and influenced postoperative outcomes in continent women with advanced POP. METHODS: This retrospective observational study included women with POP stages III-IV, without symptoms of stress urinary incontinence (SUI), who underwent surgical intervention between May 2015 and January 2020. RESULTS: A total of 226 patients met the inclusion criteria, of whom 102 (45.1%) underwent UDS. Additional diagnoses were identified in 64/102 cases (62.6%), including 21 cases (20.6%) of occult SUI. Surgical planning was modified in 20/102 patients (19.6%), with 18 recommendations for sling placement and two contraindications. The overall rate of occult SUI was 28.8% (65/226). Among 182 patients continent on physical examination (PE), 68 (37.4%) underwent UDS. Postoperatively, the UDS group maintained more pronounced urge incontinence (p = 0.006) and storage symptoms (p < 0.001) compared to the PE group. No significant difference was observed in the incidence of de novo SUI between the UDS group 6/68 (8.8%) and the PE group 11/114 (9.6%) (p = 0.853), nor in the need of postoperative sling 4/68 (5.9%) and 5/114 (4.4%), respectively. CONCLUSIONS: Preoperative UDS in women with POP stages III - IV increases diagnostic yield, influences surgical planning, and raises the number of concomitant sling procedures. However, it does not alter postoperative outcomes in patients deemed continent on PE.