Urogenital prolapse and occult stress urinary incontinence

Background: A 76-year-old female presented to an outside clinic with symptoms of pelvic prolapse; she denied stress urinary incontinence (SUI). The patient had a history of two prior anti-incontinence surgeries. Pelvic examination revealed a grade IV cystocele. No SUI was identified, with or without reduction of the prolapse. Anterior colporrhaphy with cadaveric fascia was performed. Her prolapse symptoms resolved, but she had new-onset severe SUI. Investigations: Pelvic examination, cystoscopy, urodynamics. Diagnosis: Occult SUI unmasked after anterior colporrhaphy. Management: The patient was referred to our institution where videourodynamics were performed, revealing a well-supported bladder and SUI with Valsalva leak-point pressure of 26 cm H₂0. A transvaginal polypropylene sling was placed. She had complete resolution of SUI and denied exacerbation of mild urgency.