The prognostic value of the cough test in patients suffering from pelvic organ prolapse
Article authors
Kasyan G.R., Tupikina N.V., Gvozdev M.Y., Glotov A.V., Pushkar D.Y.`
Moscow State University of Medicine and Dentistry, Dept. of Urology, Moscow, Russia
Purpose:
The purpose of the study is to examine the prognostic significance of cough test performed without and with prolapse repositioning in patients with pelvic organ prolapse (POP).
Materials and methods:
This study included 82 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients provided signed informed consent. All patients were submitted to gynecological examination with cough tests without prolapse reposition and with reposition of POP by mirrow, manually and by cubic pessary. All patients were operated by vaginal approach. Using a special statistical calculator system MedCalc we have been evaluated the diagnostic accuracy of cough tests (sensitivity, specificity, and predictive value, likelihood ratio) based on the postoperative data.
Results:
Three months after surgery, 41% of the patients (34/82) complained of stress urinary incontinence, and 70% of these (24/34) patients requested a subsequent anti-incontinence operation. No cases of prolapse recurrence were noted within three months.
According to the analysis, the most sensitive test was the cough test with a prolapse repositioning mirror (up to 73%). The test with the greatest specificity was the cough test without repositioning of POP (up to 92%), followed by the combination of tests with no reduction of POP and the reduction of POP (up to 92%) and the presence of a positive speculum and pessary test in combination with a negative manual cough test (97%).
With respect to the predictive value of any one test, no significant differences were detected. The prevalence of SUI after surgery was 41.46% (CI 95% - 30.68% to 52.88%), which may interfere with the data for the main population.
In patients who developed SUI after surgery, the probability of a positive cough test without prolapse repositioning was 3.5 times higher than it was for patients who did not develop SUI after surgery. Furthermore, in the presence of a positive result of the cough test without prolapse repositioning in patients who had POP before surgery, the risk of SUI after surgical treatment by the vaginal route increased by 4.58 times (OR 4.58, CI 95% 1.2978 -16.1860, P=0.0180); for patients who were tested with a speculum, this parameter was 4.24 (OR=4.2398, CI 95% 1.6288 - 11.0359, P = 0.0031).
| Diagnostic test | Sensitivity | Specifity | Positive prognostic value | Negative prognostic value | Positive Likelihood Ratio | Negative Likelihood Ratio | Diagnostic Odds ratio |
| Cough test without reposition (test №0), (95% CI) | 29.41% (15.12% - 47.48%) | 91.67% (80.00% - 97.63%) | 71.43% (41.92% - 91.43%) | 64.71% (52.17% - 75.91%) | 3.53 (1.21 to 10,32) | 0.77 (0.61 to 0.97) | 4.58 (1.2978 - 16.1860), P = 0.0180* |
| Cough test with mirrow (test №1), (95% CI) |
73.53 % (55.64 % до 87.09 %) | 60.42 % (45.27 % дo 74.22 %) | 56.82 % (41.04 % дo 71.64 %) | 76.32 % (59.75 %- 88.53 %) | 1.86 (1.24 to 2,78) | 0.44 (0.24 to 0,80) | 4.2398 (1.6288 - 11.0359), P = 0.0031* |
| Cough test with pessary (test №2), (95% CI) |
47,06% (29,79% до 64,86%) | 72,92% (58,15% до 84,71%) | 55,17% (35,70% до 73,54%) | 66.04% (51.73% -78.47%) | 1.74 (0.97 to 3,12) | 0.73 (0.51 to 1.04) | 2.3932 (0.9473 - 6.0456), P = 0.0650 |
| Cough test with manual reposition (test №3), (95% CI) | 50.00 % (32.44 % дo 67.56 %) | 75,00% (60,40% до 86,35%) | 58,62% (38,94% до 76,46%) | 67.92% (53.68% - 80.07%) | 2.00 (1.10 to 3.62) | 0.67 (0.46 to 0.97) | 3.0000 (1.1749 - 7.6603), P = 0.0216* |
| Combination of tests №1, 2, 3 (95% CI) | 41.18 % (24.66 % дo 59.30 %) | 75,00% (60,40% до 86,35%) | 53,85% (33,39% до 73,39%) | 64.29% (50,36% - 76.64%) | 1.65 (0.87 to 3.10) | 0.78 (0.57 to 1.09) | 2.1000 (0.8161 дo 5.4038), P = 0.1239 |
| Combination of tests №1, 2 (95% CI) | 47,06% (29,79% до 64,86%) | 75,00% (60,40% до 86,35%) | 57,14% (37,19% до 75,52%) | 66.67% (52.52% - 78.90%) | 1.88 (1.03 to 3.45) | 0.71 (0.49 to 1.01) | 2.6667 (1.0435 – 6.8149), P = 0.0405* |
| Combination of tests №1, 3 (95% CI) | 47,06% (29,79% до 64,86%) | 77,08% (62,68% до 87,95%) | 59,26% (38,81% до 77,59%) | 67.27% (53,29% - 79.31%) | 2.05 (1,09 to 3.85) | 0.69 (0.48 to 0.98) | 2.9899 (1.1538 -7.7476), P = 0.0242* |
| Combination of tests № 0, 1, 2, 3 (95% CI) |
2, 3 (95% CI) 23.53 % (10.78 % до 41.18 %) |
97,92% (88,89% to 99,65%) | 66,67% (34,95% до 89,87%) | 62.86% (50,48% - 74.11%) | 2.82 (0.92 to 8.63) | 0.83 (0.68 to 1.02) | 3.3846 (0.9275 – 12.3507), P = 0.0649 |
Conclusions:
The cough tests without prolapse repositioning and with repositioning of POP are important for determining the outcome of surgical treatment in patients suffering from POP.
Acknowledgement:
The study was funded by the grant of The Ministry of Education and Science, project 14.132.21.1784
