~9 spots leftby Dec 2025

Predictive Tests for Stress Urinary Incontinence After Pelvic Organ Prolapse Surgery

Recruiting in Palo Alto (17 mi)
+1 other location
ML
Overseen byMaryse Larouche, MD, MPH
Age: 18+
Sex: Female
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: McGill University Health Centre/Research Institute of the McGill University Health Centre
Disqualifiers: Stress urinary incontinence, Pregnancy, others
No Placebo Group

Trial Summary

What is the purpose of this trial?

The CREDE pilot randomized study will compare the intraoperative Crede manoeuver (M1) to preoperative prolapse (POP) reduction cough stress test (M2) for the prediction and prevention of PONSUI. The rates of PONSUI and its effect on patient reported outcomes and quality of life will be determined among women with positive or negative tests, and those with and without concomitant anti-incontinence procedure performed. This information will help inform larger studies on the topic.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Intraoperative Crede Manoeuver and related procedures for stress urinary incontinence after pelvic organ prolapse surgery?

The research suggests that surgical repair of pelvic organ prolapse can resolve urge incontinence, which is a different type of urinary issue, and that predicting stress urinary incontinence after such surgery is challenging. However, there is no direct evidence provided about the effectiveness of the specific treatments like the Crede Manoeuver for stress urinary incontinence.12345

Is the predictive test for stress urinary incontinence after pelvic organ prolapse surgery safe?

The research articles do not provide specific safety data for the predictive tests or procedures like the Crede Manoeuver or stress tests. However, surgeries for stress urinary incontinence are generally considered low-risk, similar to common procedures like hernia repairs.34678

How does the Intraoperative Crede Manoeuver treatment differ from other treatments for stress urinary incontinence after pelvic organ prolapse surgery?

The Intraoperative Crede Manoeuver is unique because it involves a manual technique performed during surgery to help predict stress urinary incontinence after pelvic organ prolapse surgery, rather than relying on preoperative tests or additional surgical procedures. This approach is different from other treatments that may involve preoperative screening tests or the use of devices like pessaries to assess or manage incontinence risk.3891011

Research Team

ML

Maryse Larouche, MD, MPH

Principal Investigator

St. Mary's Research Centre and RI-MUHC

Eligibility Criteria

This trial is for women with a prolapse condition (anterior, uterine or apical) that's at least moderate in severity and needs surgery. It's not for those who are pregnant, don't speak English or French, have only posterior prolapse, can't attend follow-up visits, already have stress urinary incontinence, or had previous surgeries for incontinence or urethral repair.

Inclusion Criteria

I need surgery for a significant pelvic organ prolapse.

Exclusion Criteria

I experience urine leakage when I cough, sneeze, or exercise.
My condition is a prolapse affecting only the back wall of my vagina.
I have had surgery to repair my urethra.
See 4 more

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Assessment

Participants undergo preoperative prolapse reduction cough stress test to determine eligibility for anti-incontinence procedure

1 visit
1 visit (in-person)

Surgical Intervention

Participants undergo POP surgical repair and intraoperative Crede maneuver to assess PONSUI risk and determine need for anti-incontinence procedure

1 day
1 visit (in-person)

Postoperative Follow-up

Participants are monitored for safety, effectiveness, and complications after surgery, including assessments at 6 weeks and 6 months

6 months
2 visits (in-person)

Treatment Details

Interventions

  • Intraoperative Crede Manoeuver (Procedure)
  • Preoperative Prolapse Reduction Cough Stress Test (Diagnostic Test)
Trial OverviewThe CREDE study is testing two methods to predict and prevent new-onset stress urinary incontinence after pelvic organ prolapse surgery: the intraoperative Crede manoeuver versus a preoperative cough test. The impact on patient outcomes and quality of life will also be assessed.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Intraoperative Crede manoeuverExperimental Treatment1 Intervention
Method 1 (M1) consists in intraoperative Crede maneuver: After POP surgical reduction, the bladder will be retrograde filled with 300 ml of sterile water through a catheter that will then be removed. Brief and forceful suprapubic pressure will be applied. The test is positive if the surgeon visualizes a urinary leak. In this group, the intraoperative Crede manoeuver will determine if an anti-incontinence procedure should be performed concomitantly.
Group II: Preoperative prolapse reduction cough stress testActive Control1 Intervention
An examiner will perform the test preoperatively in the office, at the same visit as the recruitment. With a volume of 250-350 mL of urine in the bladder (confirmed by bladder scanner), a prolapse reduction cough stress test will be performed (posterior speculum blade for reduction). The test is positive if the examiner visualizes a urinary leak. In this group, the preoperative prolapse reduction cough stress test will determine if an anti-incontinence procedure should be performed concomitantly.

Find a Clinic Near You

Research Locations NearbySelect from list below to view details:
St. Mary's HospitalMontreal, Canada
McGill University Health CentreMontréal, Canada
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Who Is Running the Clinical Trial?

McGill University Health Centre/Research Institute of the McGill University Health Centre

Lead Sponsor

Trials
476
Patients Recruited
170,000+

St. Mary's Research Centre, Montreal

Collaborator

Trials
1
Patients Recruited
100+

Findings from Research

Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse.Nguyen, JK., Bhatia, NN.[2004]
[Value of postoperative urodynamic assessment for long-term urinary function results after treatment of genital prolapse. 103 examinations after treatment of genital prolapse].Therby, D., Viala, F., Cosson, M., et al.[2006]
External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery.Yasa, C., Gungor Ugurlucan, F., Dural, O., et al.[2021]
Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes.Duecy, EE., Pulvino, JQ., McNanley, AR., et al.[2012]
Postoperative detrusor contractility temporarily decreases in patients undergoing pelvic organ prolapse surgery.Kitta, T., Mitsui, T., Kanno, Y., et al.[2015]
Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network.Erekson, E., Whitcomb, EL., Kamdar, N., et al.[2023]
Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: a survey within a mixed methods feasibility study.Hilton, P., Bryant, A., Howel, D., et al.[2022]
Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test.van der Ploeg, JM., Steyerberg, EW., Zwolsman, SE., et al.[2020]
The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study.Song, X., Zhu, L., Ding, J.[2018]
The study involved 137 women and found a significant association between occult incontinence and the risk of developing postoperative stress urinary incontinence (POSUI) after pelvic organ prolapse surgery.
Despite the association, the tests used to identify women at risk for POSUI showed poor predictive performance at the individual level, indicating that occult incontinence alone is not a reliable indicator for recommending prophylactic anti-incontinence procedures.
Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery.Svenningsen, R., Borstad, E., Spydslaug, AE., et al.[2022]
Pessary test in women with urinary incontinence.Bhatia, NN., Bergman, A.[2009]

References

Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. [2004]
[Value of postoperative urodynamic assessment for long-term urinary function results after treatment of genital prolapse. 103 examinations after treatment of genital prolapse]. [2006]
External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery. [2021]
Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes. [2012]
Postoperative detrusor contractility temporarily decreases in patients undergoing pelvic organ prolapse surgery. [2015]
Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network. [2023]
Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: a survey within a mixed methods feasibility study. [2022]
Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test. [2020]
The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study. [2018]
Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery. [2022]
11.United Statespubmed.ncbi.nlm.nih.gov
Pessary test in women with urinary incontinence. [2009]