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International Scholarly Research Network
ISRN Urology
Volume 2012, Article ID 109858, 8 pages
Clinical Study
Outcome Assessment of theMarshall Coughing Test during
Cervix RepositionManeuver inWomen with Urinary Stress
Incontinence with/without Genital Prolapse
Vesna Antovska
Department for Urogynaecology and Pelvic Floor Disorders, University Clinic forGynaecology and Obstetrics, Medical Faculty,
University “Saint Cyril and Methodius”, Vodnjanska 17, 1000 Skopje, Macedonia
Correspondence should be addressed to Vesna Antovska, vantovska@yahoo.com
Received 22 November 2011; Accepted 11 December 2011
Academic Editors: C. E. Constantinou and M. Salido
Copyright © 2012 Vesna Antovska. This is an open access article distributed under the Creative CommonsAttribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives. Outcome assessment of the Marshall coughing test (MT) during cervix reposition maneuver (CRM) in women with
urinary stress incontinence (USI) with/without genital prolapse (GP). Study Design. 268 patients, divided into USIg (n = 132) withisolated USI and USIGPg (n = 136) with USI and GP stage I/II, additionally divided into USIGP(A) (n = 78) with USI and GP
stage I and USIGP(B) (n = 58) with USI and GP stage II, were evaluated with pelvic organ prolapse quantification (POPQ), MT,
and CRM. Results. (a) 7.58% had (+) MT with CRM in USIg; (b) in up to 96.15% MT became negative during CRM in USIGP(A);
(c) in 51.72% MT becamepositive only during CRM, as a sign for occult USI in USIGP(B); (d) point Aa (POPQ), which is bladder
neck(BN) projection on the anterior vaginal wall, was situated higher in rest position (RP), but moved lower during the Valsalva
maneuver (VM) in USIg versus USIGPg (P < 0.05). Conclusion. CRM could be useful arm in selection of (1) patients with isolated
USI and great chance for postoperativefailure; (2) patients with USI+GP stage I, who need GP repair during antistress surgery;
(3) patients with USI + GP stage II, who need antistress procedure during vaginal hysterectomy.
1. Introduction
Women with genital prolapse (GP) may be continent
paradoxically, as a result of urethral kinking or compression,
but after repair of GP, 22–80% of patients will present de
novo urinary stressincontinence (USI) [1]. These women
have occult USI and can be preoperatively identified by
performing the barrier test, which is actually a stress test
to determine whether urine leakage occurs during GPreposition.
This test can be performed in several different
ways, such as using a pessary, vaginal pack, or Sims’ speculum
or performing the cervix reposition maneuver (CRM), which
is simpleimitation of postoperative pelvic organ position
with grasping the cervix with tenaculum and pushing it
in upwards/backwards direction to the promontorium. The
barrier test can also be performed during urodynamic investigation
in sitting position with the bladder at maximum
cystometric capacity, because if it is performed at a lower
bladder volume, the prolapse may still mask USI. Klutke
andRamos [2] suggested that a negative reposition test is
reliable in the prediction of patient who will be stress continent
after prolapse repair. Gordon et al. [3] reported that
50% of clinically continent women with severe pelvic organ
prolapse, who had a preoperative positive barrier test, experienced
de novo USI after prolapse repair. Lecuru et al. [4]
in their series of 203 abdominalcorrection of GP reported
86.7 to 100% anatomically good long-term results, but only
53.3 to 80.5% functionally good. In a study of 191 patients
with GP [5], in 50% this prolapse was combined with USI.
Vaginal prolapse recurred after 4 and 12 months in 4 and 6%
of cases, respectively, but up to 31% still complained of USI 4
months after the operation. Morley and DeLancey [6] in 57
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