World Journal of Urology

, Volume 37, Issue 1, pp 189–193 | Cite as

Is urodynamics necessary to identify occult stress urinary incontinence?

  • Susane Mei HwangEmail author
  • Luís Gustavo Morato de Toledo
  • Silvia da Silva Carramão
  • Armando Brites Frade
  • Andre Costa Matos
  • Antonio Pedro Flores Auge
Original Article



To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods.


This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction.


The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441–.854).


UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.


Pelvic organ prolapse Urinary incontinence, Stress Urodynamics Physical exam Diagnosis 


Author contributions

SM Hwang: Protocol/Project development, data collection and management, data analysis, manuscript writing/editing. LGM Toledo: Protocol/Project development, manuscript writing/editing. SS Carramão: Protocol/Project development. AB Frade: Protocol/Project development. AC Matos: Data analysis. APF Auge: Protocol/Project development, Manuscript wiriting/editing.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human participants

The study was approved by the Institutional Research Ethics committee of the two participating hospitals. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Susane Mei Hwang
    • 1
    Email author
  • Luís Gustavo Morato de Toledo
    • 2
  • Silvia da Silva Carramão
    • 1
  • Armando Brites Frade
    • 1
  • Andre Costa Matos
    • 3
  • Antonio Pedro Flores Auge
    • 1
  1. 1.Department of Obstetrics and Gynecology, Urogynecology ServiceSanta Casa de Sao Paulo School of Medical SciencesSão PauloBrazil
  2. 2.Department of Surgery, Urology ServiceSanta Casa de Sao Paulo School of Medical SciencesSão PauloBrazil
  3. 3.Department of Surgery, Urology ServiceHospital São RafaelSalvadorBrazil

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