Tests
1st tests to order
assessment of postvoid residual urine (PVR) volume
Test
Women with advanced prolapse often have voiding difficulties, which may result in urinary retention, recurrent urinary tract infection, and, in rare cases, damage to the renal parenchyma.[22] Investigation is accomplished with a sterile transurethral catheter or bladder ultrasound.[27]
Result
elevated urine retention PVR volume
urinalysis
Test
Women with advanced pelvic organ prolapse and voiding dysfunction are at higher risk for urinary tract infections (symptomatic or asymptomatic), and urinalysis may indicate this in many cases.[28][29] As infection is known to exacerbate incontinence symptoms, detection and treatment of infection is a critical element of the evaluation.[27] Gross hematuria or persistent microhematuria warrant evaluation for neoplastic processes in the urinary tract.
Result
normal, unless concomitant urinary tract infection is present
Tests to consider
urodynamics
Test
Urodynamic testing is used in clinical care for two main reasons. In women without symptoms of stress incontinence, urodynamic testing, with reduction of the prolapse by pessary or swab, has been used to guide the recommendation for concomitant anti-incontinence procedures at the time of pelvic organ prolapse repair.[19] For women with symptoms of stress incontinence, urodynamic testing has been used to select the optimal anti-incontinence procedure, although there are no clear evidence-based recommendations for the superiority of any specific continence procedure in stress-incontinent women undergoing prolapse repair.[27]
Result
distinguishes stress incontinence and/or detrusor overactive incontinence
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