Ambulatory Pessary Trial

Ambulatory Pessary Trial as a Preoperative Method for Diagnosing Occult Stress Urinary Incontinence

The purpose of this study is to compare two methods for assessing patients with pelvic organ prolapse for occult stress urinary incontinence. Urodynamic testing is the most widely accepted and well-studied method for diagnosing occult stress urinary incontinence preoperatively, but an ambulatory pessary trial is a less expensive option that is available to a wider group of practitioners and evaluates patient while they are engaged in their daily activities.

Inclusion Criteria:

• Female
• Patients planning to undergo pelvic organ prolapse surgery and preoperative urodynamic testing within 6 months of recruitment.
• Stage 2 or greater pelvic organ prolapse on pre op POP-Q exam
• Negative stress test on clinical exam
• Cognitive capacity to complete questionnaires and voiding diary

Exclusion Criteria:

• Stress incontinence during provocative stress test on pre-operative exam.
• Occult stress urinary incontinence demonstrated on pre-operative physical exam
• Known ability to retain a pessary for the 3 day trial
• < age 18
• History of bladder augmentation or artificial sphincter
• Known neurologic disease effecting bladder (spinal cord injury, Multiple Sclerosis, Parkinson's Disease, etc.)
• Non ambulatory patients
• Active infections of the vagina or pelvis (Pelvic inflammatory disease, infectious vaginitis, etc.)
• Occult stress urinary incontinence demonstrated on pre-operative physical exam
• Known ability to retain a pessary for the 3 day trial
• < age 18
• History of bladder augmentation or artificial sphincter
• Known neurologic disease effecting bladder (spinal cord injury, Multiple Sclerosis, Parkinson's Disease, etc.)
• Non ambulatory patients
• Active infr