Identifying Stress Urinary Incontinence in Women With Pelvic Organ Prolapse

NCT03005977 | Completed

• 1 other identifier: FLA 16-078
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

What test is most sensitive in identifying stress urinary incontinence in women with pelvic organ prolapse; urodynamics, cough stress test, or pyridium pad test? The hypothesis states that there is a difference between the sensitivity of UDS, pyridium pad test and cough stress tests, with UDS being the most sensitive and the gold standard in identifying SUI in patients with pelvic organ prolapse.

Conditions

Stress Urinary Incontinence; Pelvic Organ Prolapse

Keywords

Urodynamics; Pyridium pad test; Cough stress test; Pelvic organ prolapse

Outcome Measures

Primary Outcomes (3)

• Number of patients with SUI as per Pelvic Floor Bother Questionnaire prior to prolapse surgery compared to number of patients with clinical SUI identified on either UDS, pyridium pad test and cough stress test.

  Pelvic Floor Bother Questionnaire:A comparison will be made for each patient across the three studies to identify which test is most predictive of patient's SUI indicated by leakage identified on patients pre-operative questionnaire: Pelvic Floor Bother Questionnaire.

  2 years

• Number of patients with SUI as per the Urogenital Distress Inventory (UDI-6):Questionnaire prior to prolapse surgery compared to number of patients with clinical SUI identified on either UDS, pyridium pad test and cough stress test.

  The Urogenital Distress Inventory (UDI-6):A comparison will be made for each patient across the three studies to identify which test is most predictive of patient's SUI indicated by leakage identified on patients pre-operative questionnaire: the Urogenital Distress Inventory (UDI-6)

  2 years

• Number of patients with SUI as per The numerical analog scale prior to prolapse surgery compared to number of patients with clinical SUI identified on either UDS, pyridium pad test and cough stress test.

  The numerical analog scale.A comparison will be made for each patient across the three studies to identify which test is most predictive of patient's SUI indicated by leakage identified on patients pre-operative questionnaire: the numerical analog scale.

  2 years

Study Arms (1)

Urodynamics, pyridium pad & cough stress

OTHER

The Pelvic Floor Bother Questionnaire, a questionnaire standardized by Cleveland Clinic Florida, the Urogenital Distress Inventory (UDI-6), and the numerical analog scale are to be administered prior to and 6 weeks after the surgical intervention. (14, 15) Prior to surgery, patients will be scheduled for a UDS performed by a qualified nurse practitioner or physician and will be given instructions in verbal and written form to undergo a 24 H pyridium pad test at least 72 hours before the UDS. Patients will be given pyridium TID and report if orange stain is noted on their pad in this period of time. A supine and a standing cough stress test will also be performed.

Procedure: Urodynamics

Interventions

Urodynamics PROCEDURE

UDS is to be performed with prolapse reduced by a speculum. The patient will be asked to valsalva three times then cough while seated after 150 ml of fluid is instilled in the bladder and then again at 300 ml. The same provocative measures will be performed at capacity, with the catheter in place and without the catheter if no leak is identified. If the patient leaks at any volume or if the patient leaks during the cough pressure profile (CPP), the test will be considered positive. If the patient does not leak during filling nor during the CPP then the test will be considered negative.

Also known as: 24 hour pyridium pad test, Cough stress test

Urodynamics, pyridium pad & cough stress

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• y/o or greater
• Able to consent
• Stage 2 or greater prolapse
• With or without complaint of stress urinary incontinence

You may not qualify if:

• Desire non-surgical management
• Prior surgery for prolapse or incontinence
• Treated medically for incontinence in the past 4 weeks
• Current Infection
• Known neurologic condition
• Stage 3 or greater chronic kidney disease

Sponsors & Collaborators

• The Cleveland Clinic: lead

Study Sites (1)

Cleveland Clinic Florida

Weston, Florida, 33331, United States

Location

Related Publications (16)

• Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997 Apr;89(4):501-6. doi: 10.1016/S0029-7844(97)00058-6.

  PMID: 9083302 BACKGROUND

• Latini JM, Kreder KJ Jr. Associated pelvic organ prolapse in women with stress urinary incontinence: when to operate? Curr Opin Urol. 2005 Nov;15(6):380-5. doi: 10.1097/01.mou.0000179760.45715.9b.

  PMID: 16205487 BACKGROUND

• Kasturi S, Diaz SI, McDermott CD, Woodman PJ, Bump RC, Terry CL, Hale DS. De novo stress urinary incontinence after negative prolapse reduction stress testing for total vaginal mesh procedures: incidence and risk factors. Am J Obstet Gynecol. 2011 Nov;205(5):487.e1-4. doi: 10.1016/j.ajog.2011.07.006. Epub 2011 Jul 20.

  PMID: 21925638 BACKGROUND

• Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, Amundsen CL, Schaffer J, Meikle SF, Spino C; Pelvic Floor Disorders Network. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012 Jun 21;366(25):2358-67. doi: 10.1056/NEJMoa1111967.

  PMID: 22716974 BACKGROUND

• Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, Zyczynski H, Brown MB, Weber AM; Pelvic Floor Disorders Network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006 Apr 13;354(15):1557-66. doi: 10.1056/NEJMoa054208.

  PMID: 16611949 BACKGROUND

• Martin JL, Williams KS, Abrams KR, Turner DA, Sutton AJ, Chapple C, Assassa RP, Shaw C, Cheater F. Systematic review and evaluation of methods of assessing urinary incontinence. Health Technol Assess. 2006 Feb;10(6):1-132, iii-iv. doi: 10.3310/hta10060.

  PMID: 16487456 BACKGROUND

• Price DM, Noblett K. Comparison of the cough stress test and 24-h pad test in the assessment of stress urinary incontinence. Int Urogynecol J. 2012 Apr;23(4):429-33. doi: 10.1007/s00192-011-1602-1. Epub 2011 Nov 16.

  PMID: 22086265 BACKGROUND

• Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2007 Apr;97(1):31-4. doi: 10.1016/j.ijgo.2006.12.011. Epub 2007 Feb 8.

  PMID: 17291508 BACKGROUND

• W. Henderson, S. Kane, J. Mangel, J. Garibay, E. Kikano, R. Pollard, S. T. Mahajan, A. Hijaz. A randomized comparative study correlating cough stress test with urodynamics and 24 hour pad test in the evaluation of stress urinary incontinence. J. Female Pelvic Medicine & Reconstructive Surgery Issue: September/October 2015. Volume 21(5) Supplement 1, p S11

  BACKGROUND

• Artibani, W; Andersen, JT; Gajewski, JB; Ostergard, DR; Raz, S; Tubaro, A; Chapter 8C imaging and other Investigations. 2nd International Consultation on Incontinence 2002 p425-477

  BACKGROUND

• Wall LL, Wang K, Robson I, Stanton SL. The Pyridium pad test for diagnosing urinary incontinence. A comparative study of asymptomatic and incontinent women. J Reprod Med. 1990 Jul;35(7):682-4.

  PMID: 2198349 BACKGROUND

• Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, Zyczynski H, Brown MB, Weber AM; Pelvic Floor Disorders Network. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008 May;19(5):607-14. doi: 10.1007/s00192-007-0498-2. Epub 2008 Jan 9.

  PMID: 18185903 BACKGROUND

• Peterson TV, Karp DR, Aguilar VC, Davila GW. Validation of a global pelvic floor symptom bother questionnaire. Int Urogynecol J. 2010 Sep;21(9):1129-35. doi: 10.1007/s00192-010-1148-7. Epub 2010 May 11.

  PMID: 20458467 BACKGROUND

• Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131-9. doi: 10.1002/nau.1930140206.

  PMID: 7780440 BACKGROUND

• Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. doi: 10.1007/s00192-009-0976-9. Epub 2009 Nov 25.

  PMID: 19937315 RESULT

• Martin L, Ossin D, Schachar J, Devakumar H, Alas A, Davila GW, Reis IM, Miao F, Hurtado E. Comparison of Methods to Identify Stress Urinary Incontinence in Women With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e127-e132. doi: 10.1097/SPV.0000000000000858.

  PMID: 33369965 DERIVED

MeSH Terms

Conditions

Urinary Incontinence, Stress; Pelvic Organ Prolapse

Interventions

Urodynamics

Condition Hierarchy (Ancestors)

Urinary Incontinence; Urination Disorders; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Prolapse; Pathological Conditions, Anatomical

Intervention Hierarchy (Ancestors)

Urinary Tract Physiological Phenomena; Reproductive and Urinary Physiological Phenomena

Study Officials

• Eric Hurtado, MD

  The Cleveland Clinic

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SCREENING
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Urogynecology Clinical Fellow

Study Record Dates

• First Submitted: December 15, 2016
• First Posted: December 30, 2016
• Study Start: February 15, 2017
• Primary Completion: November 30, 2021
• Study Completion: December 31, 2021
• Last Updated: April 7, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)