What is the role of a pessary trial in the workup of urinary incontinence?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

A pessary trial may be useful in the preoperative evaluation of female patients who have severe pelvic organ prolapse but no complaints of urinary incontinence. After being fitted with a pessary, which effectively reduces her prolapse, the patient is asked to wear the pessary for a few days during usual activities.

In some instances, the patient may experience stress incontinence while using the pessary. Some experts consider this to be evidence of so-called occult or potential stress incontinence—in other words, that stress incontinence may develop after surgical correction of the prolapse in these patients, because kinking of the urethra and/or limitation of urethral mobility secondary to the large prolapse may contribute to their continence.

The preoperative diagnosis of potential stress incontinence prompts the surgeon to add an anti-incontinence procedure to the overall surgical management scheme.


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