Utilizing preoperative 20-minute pad testing with vaginal gauze packing for indicating concomitant midurethral sling during cystocele repair

Objective: To investigate the feasibility of using preoperative 20-minute pad testing with vaginal gauze packing for cystocele reduction to indicate a concomitant midurethral sling during cystocele repair. Study design: Retrospective review of the records of consecutive women with pelvic organ prolapse quantification >= stage II symptomatic cystocele who visited the urogynecologic outpatient clinics and underwent cystocele repair between July 2005 and December 2010. Only patients who underwent preoperative urodynamic studies and 20-minute pad testing with vaginal gauze packing for cystocele reduction were enrolled. Results: Twenty-one patients did not demonstrate any stress urinary incontinence. For evident stress urinary incontinence (>1 g pad weight before reduction), the criterion of >= 8 g pad weight before reduction was chosen for concomitant midurethral sling. For patients with occult stress urinary incontinence (<= 1 g pad weight before reduction), the criterion of >= 8 g pad weight after reduction was chosen as an indication for concomitant midurethral sling. Among 22 patients with evident stress urinary incontinence (<8 g) without concomitant midurethral sling, only one patient (4.5%) received a midurethral sling during the follow-up period (median follow-up interval: 30.5 months). Among 21 patients with occult stress incontinence but <8 g after reduction without concomitant midurethral sling, only one patient (4.8%) received midurethral sling during the follow-up period (median follow-up interval: 38 months). Conclusions: A preoperative 20-minute pad test with vaginal gauze packing for cystocele reduction is a feasible and practical method to decide for a concomitant midurethral sling. Crown Copyright (C) 2013 Published by Elsevier Ireland Ltd. All rights reserved.