1
|
Powell TC, Meyer I, Redden DT, Maier J, Nguyen C, Richter HE. Pain Catastrophizing and Impact on Pelvic Floor Surgery Experience. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:946-952. [PMID: 37195629 DOI: 10.1097/spv.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
IMPORTANCE Understanding patients' perceptions of symptoms and outcomes of urogynecologic surgery is essential for providing high-quality care. OBJECTIVE The aim of the study was to assess association of pain catastrophizing with pelvic floor symptom distress and impact, postoperative pain, and voiding trial in patients undergoing urogynecologic surgery. STUDY DESIGN Individuals whose self-identified gender was female and were undergoing surgery March 2020-December 2021 were included. Participants completed the Pain Catastrophizing Scale (range 0-52), Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire preoperatively. Pain catastrophizing was score ≥30 and describes the tendency to magnify the overall threat of pain. Voiding trial failure was inability to void ≥2/3 of instilled volume (≤300 mL). The association between pain catastrophizing and symptom distress and impact was assessed with linear regression. A P < 0.05 is significant. RESULTS Three hundred twenty patients were included (mean age, 60 years, 87% White). Forty-six of 320 participants (14%) had a pain catastrophizing score ≥30. The pain catastrophizing group had higher body mass index (33 ± 12 vs 29 ± 5), more benzodiazepine use (26% vs 12%), greater symptom distress (154 ± 58 vs 108 ± 60), and greater urogenital (59 ± 29 vs 47 ± 28), colorectal (42 ± 24 vs 26 ± 23), and prolapse (54 ± 24 vs 36 ± 24) subscale scores, all P ≤ 0.02. The pain catastrophizing group had greater impact (153 ± 72 vs 72 ± 64, P < 0.01) and urogenital (60 ± 29 vs 34 ± 28), colorectal (36 ± 33 vs 16 ± 26), and prolapse (57 ± 32 vs 22 ± 27) subscale scores, P < 0.01. Associations remained controlling for confounders ( P < 0.01). The pain catastrophizing group had higher 10-point pain scores (8 vs 6, P < 0.01) and was more likely to report pain at 2 weeks (59% vs 20%, P < 0.01) and 3 months (25% vs 6%, P = 0.01). Voiding trial failure did not differ (26% vs 28%, P = 0.98). CONCLUSIONS Pain catastrophizing is associated with greater pelvic floor symptom distress and impact and postoperative pain but not voiding trial failure.
Collapse
Affiliation(s)
- T Clark Powell
- From the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology
| | - Isuzu Meyer
- From the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology
| | | | - Julia Maier
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christine Nguyen
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E Richter
- From the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology
| |
Collapse
|
2
|
Çetinel B, Kırlı EA, Önal B, Kalender G, Demirbilek M, Okur A, Can G. Voiding dynamics of pelvic organ prolapse: Large scale comparative study. Neurourol Urodyn 2023; 42:736-745. [PMID: 36806102 DOI: 10.1002/nau.25156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To determine the voiding dynamics of the patients with pelvic organ prolapse (POP). MATERIALS AND METHODS A retrospective patient file review was performed of 877 female patients with lower urinary tract symptoms. After exclusion criteria 373 female patients were eligible for the study. Two patient groups w/wo prolapse were identified. The symptoms, patient characteristics, patterns of free urine flow, and detrusor voiding pressure curves were compared between two groups. A comparison of the urodynamic findings between the subgroups (mild/moderate, severe, and w/o prolapse) was made and shown on a scatter plot graphics of Pdet Qmax versus Qmax as well. RESULTS A total of 373 patients with median age 54 (18-92), 189 (51%) had varying degrees and forms of POP while 184 (49%) did not have any prolapse (p < 0.003). Logistic regression analysis results showed that older age [p = 0.023, odds ratio (OR) = 1.01, confidence interval (CI): (1.00-1.03)], weaker pelvic floor muscle strength [p = 0.032, OR = 1.67, CI: (1.04-2.69)], more frequent symptom of hesitancy [p = 0.003 OR = 2.15 CI: (1.29-3.58)], prolonged-tailed shaped curve pattern of free urine flow [p = 0.027 OR = 1.97 CI: (1.08-3.58)], and higher Pdet Qmax (22 cmH2 O) values [p = 0.002, OR = 1.02, CI: (1.00-1.03)] were the independent different features of the patients with prolapse. Subgroup urodynamic analysis showed significantly lower free flowmetry Qmax and higher Pdet Qmax values in patients with severe prolapse. Prolonged/tailed-shaped curve pattern of free urine flow was significantly more frequent in patients with prolapse. CONCLUSIONS Voiding dynamics of the patients with prolapse were significantly different from the patients' w/o prolapse. They had higher Pdet Qmax values, more frequent symptom of hesitancy, and prolonged shaped free flow curve pattern. Free flow Qmax values were lower in patients with severe prolapse.
Collapse
Affiliation(s)
- Bülent Çetinel
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif A Kırlı
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Göktuğ Kalender
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhammet Demirbilek
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alper Okur
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
3
|
Characteristics Associated With Postoperative Catheterization at Discharge in Women Undergoing Colpocleisis. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:75-79. [PMID: 36548107 DOI: 10.1097/spv.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Although transient voiding dysfunction is common after surgical correction of pelvic organ prolapse, it has not been well studied in women undergoing colpocleisis. OBJECTIVE This study aimed to identify characteristics associated with discharge home with a urinary catheter in women undergoing colpocleisis. STUDY DESIGN This is a secondary analysis of a multicenter prospective study examining the effect of pelvic support, symptoms, and satisfaction in women undergoing colpocleisis. Publicly accessible deidentified data sets of the index study were analyzed. Primary outcome was discharge with a urinary catheter postoperatively. Characteristics associated with discharge with catheter after colpocleisis were assessed via logistic regression. Covariates were selected based on statistical significance at 0.05 and clinical relevance on bivariate analysis. RESULTS Of the 136 women (mean age, 77.8 ± 5.5 years) undergoing colpocleisis in the index study, 68 (50.0%) were discharged with catheter. Baseline characteristics did not differ, except that the catheter group had lower prior incontinence surgery (7.4% vs 22.1%, P = 0.02) and higher preoperative postvoid residual volume (PVR; 189.8 ± 187.6 vs 91.3 ± 124.2 mL, P < 0.01). Those discharged with catheter had greater estimated blood loss (128.7 ± 88.5 vs 95.3 ± 74.5 mL, P = 0.02), operative time (125.2 ± 56.3 vs 100.8 ± 45.4 minutes, P < 0.01), and concomitant levator myorrhaphy (82.4% vs 58.8%, P < 0.01). Multivariable analysis revealed preoperative PVR (adjusted odds ratio, 1.2; 95% confidence interval, 1.0-1.4 for every 50-mL increase in PVR) and levator myorrhaphy (adjusted odds ratio, 4.3; 95% confidence interval, 1.6-11.3) were associated with postoperative catheterization. CONCLUSIONS In women undergoing colpocleisis, higher preoperative PVR and levator myorrhaphy were associated with discharge with catheter.
Collapse
|
4
|
Abstract
The multifactorial pathophysiology of pelvic floor disorder accounts for the coexistence of several pelvic floor disorders in many women. Up to 54% of women with pelvic organ prolapse (POP) report concurrent stress urinary incontinence (SUI). While POP is a risk factor for coexistent SUI, apical and anterior prolapse can also conceal SUI symptoms that are unmasked by POP repair, resulting in de novo SUI postoperatively. It is important for pelvic reconstructive surgeons to consider the relationship between POP and urinary incontinence in presurgical planning and to discuss with patients the risks and advantages of concurrent versus staged anti-incontinence procedures.
Collapse
|
5
|
Timing and Success of Postoperative Voiding Trial After Colpocleisis With and Without Concomitant Midurethral Sling. Female Pelvic Med Reconstr Surg 2020; 27:e608-e613. [PMID: 33332854 DOI: 10.1097/spv.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare failure rates of first voiding trial (VT) within 7 days and on postoperative day (POD) 1 after colpocleisis with versus without concomitant midurethral sling (MUS). Predictors of POD 1 VT failure were also examined. METHODS This was a retrospective cohort study of women undergoing colpocleisis from January 2012 to October 2019 comparing VT outcomes with versus without MUS. Primary outcome was first VT failure within 7 days; outcomes of VTs performed on POD 1 were also assessed. Association between MUS and VT failure and predictors of POD 1 VT failure were assessed via logistic regression. RESULTS Of 119 women, 45.4% had concomitant MUS. First VT was performed on mean POD 3.1 ± 2.2 in the MUS group versus POD 1.8 ± 1.8 in the no MUS group (P < 0.01). The MUS group was less likely to undergo POD 1 VT (50% vs 83%, P < 0.01). Failure of the first VT did not differ (22.2% with MUS vs 32.8% without MUS, P = 0.20); no association between VT failure and MUS was noted (adjusted odds ratio [aOR], 0.6; 95% confidence interval [CI], 0.18-2.1). There were 68.1% (81/119) of participants who underwent POD 1 VT, MUS was performed in 33.3% (27/81). The POD 1 failure did not differ between those with 33.3% versus 40.7% without MUS (P = 0.52). Midurethral sling was not associated with POD 1 VT failure (aOR, 0.93; 95% CI, 0.27-3.23). In women undergoing POD 1 VT, preoperative postvoid residual was associated with VT failure (aOR, 1.39; 95% CI, 1.01-1.92). CONCLUSIONS In women undergoing colpocleisis, MUS was not associated with VT failure within 7 days or on POD 1. Increased preoperative postvoid residual was associated with POD 1 VT failure.
Collapse
|
6
|
[Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines]. Prog Urol 2017; 26 Suppl 1:S8-S26. [PMID: 27595629 DOI: 10.1016/s1166-7087(16)30425-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? MATERIAL AND METHODS This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). RESULTS It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. CONCLUSION Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
Collapse
|
7
|
Abdullah B, Nomura J, Moriyama S, Huang T, Tokiwa S, Togo M. Clinical and urodynamic assessment in patients with pelvic organ prolapse before and after laparoscopic sacrocolpopexy. Int Urogynecol J 2017; 28:1543-1549. [DOI: 10.1007/s00192-017-3306-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/21/2017] [Indexed: 12/01/2022]
|
8
|
Liang CC, Chang YL, Lin YH, Chang SD. Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse. Menopause 2013; 20:813-7. [DOI: 10.1097/gme.0b013e31827f09a0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Dancz CE, Ozel B. Is there a pelvic organ prolapse threshold that predicts bladder outflow obstruction? Int Urogynecol J 2011; 22:863-8. [PMID: 21340645 DOI: 10.1007/s00192-011-1373-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/28/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine if there is a cutpoint of anterior vaginal wall prolapse which predicts bladder outflow obstruction. METHODS Subjects with and without bladder outflow obstruction (BOO) were identified. Baseline characteristics, urodynamics, and exam findings were compared. RESULTS Forty-seven women with BOO were compared to 115 women without BOO. Those with obstruction were significantly older (53.9 vs. 50.0 years, p = 0.015) had higher parity (p = 0.03), significantly smaller maximum bladder capacity (359.0 vs. 426.0 ml, p < 0.0001), and were less likely to leak at smaller volumes (213.0 vs. 109.0 ml, p = 0.006) than those without obstruction. Those with obstruction also had higher measurements on Aa (p = 0.004) and Ba (p = 0.001), though receiver operator curve analysis did not reveal a clear point of anterior prolapse at which bladder outflow obstruction occurs. CONCLUSIONS Bladder outflow obstruction is associated with anterior vaginal wall prolapse, though there is no clear cutpoint of anterior prolapse which predicts obstruction.
Collapse
Affiliation(s)
- Christina E Dancz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 518, Los Angeles, CA 90033, USA.
| | | |
Collapse
|
10
|
Mahendru R. An effective and safe innovation for the management of vault prolapse. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2010; 4:6. [PMID: 20958980 PMCID: PMC2967552 DOI: 10.1186/1750-1164-4-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 10/19/2010] [Indexed: 12/19/2022]
Abstract
Objective Considering the great variety of techniques and disagreement about the ideal route, there is a need for a simple, safe and effective method for the management of vault prolapse. Study Design 51 cases of post- hysterectomy vault prolapse: 45 following vaginal and 6 after total abdominal hysterectomy were treated surgically by anterior abdominal wall colpopexy with autogenous rectus fascia strips. Results Except for minor complaints like vomiting, fever and urinary retention in 3.92% cases each (n = 2 each), no major complications were encountered. Moreover, no recurrence, thus far, on follow-up. Conclusion Using autogenous rectus fascia strips in anterior abdominal wall colpopexy is not only simple, cheap and effective method of treating apical prolapse but is also devoid of any serious complications as described with other techniques.
Collapse
Affiliation(s)
- Rajiv Mahendru
- Department of Obs & Gyn, Institute M,M,I,M,S,R,, Mullana, Ambala, Haryana, India.
| |
Collapse
|
11
|
Urodynamic Prediction of Occult Stress Urinary Incontinence Before Vaginal Surgery for Advanced Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2010; 16:215-7. [DOI: 10.1097/spv.0b013e3181e4f11e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Mahendru R. Rectus fascia colpopexy for post-hysterectomy vault prolapse: a valid option. J Turk Ger Gynecol Assoc 2010; 11:69-72. [PMID: 24591901 DOI: 10.5152/jtgga.2010.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 03/21/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Considering the great variety of techniques and disagreement about the ideal route, there is a need for a safe, simple and effective method for the management of apical prolapse. MATERIAL AND METHODS Twenty seven cases of post- hysterectomy vault prolapse (twenty four following vaginal and three after total abdominal hysterectomy) were treated surgically by anterior abdominal wall colpopexy with autogenous rectus fascia strips. RESULT Except for minor complaints like- vomiting, fever and urinary retention in 3.7% cases each (n=1), no major complications were encountered. Moreover, no recurrence, on follow-up thus far. CONCLUSION Using autogenous rectus fascia strips in anterior abdominal wall colpopexy is not only a simple, cheap and effective method of treating vault prolapse but is also devoid of any serious complications such as described with other techniques.
Collapse
Affiliation(s)
- Rajiv Mahendru
- Department of Obs Gyn, Mmimsr, Mullana, Ambala, Haryana, India
| |
Collapse
|
13
|
Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery. Int Urogynecol J 2010; 21:1143-9. [PMID: 20419366 PMCID: PMC2910298 DOI: 10.1007/s00192-010-1152-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 03/22/2010] [Indexed: 11/09/2022]
Abstract
Introduction and hypothesis This study focussed on the factors which predict the presence of symptoms of overactive bladder (OAB) after surgery for pelvic organ prolapse (POP). Methods Consecutive women who underwent POP surgery with or without the use of vaginal mesh materials in the years 2004–2007 were included. Assessments were made preoperatively and at follow-up, including physical examination (POP-Q) and standardised questionnaires (IIQ, UDI and DDI). Results Five hundred and five patients were included with a median follow-up of 12.7 (6–35) months. Bothersome OAB symptoms decreased after POP surgery. De novo bothersome OAB symptoms appeared in 5–6% of the women. Frequency and urgency were more likely to improve as compared with urge incontinence and nocturia. The best predictor for the absence of postoperative symptoms was the absence of preoperative bothersome OAB symptoms. Conclusion The absence of bothersome OAB symptoms preoperatively was the best predictor for the absence of postoperative symptoms.
Collapse
|
14
|
de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, Kirby MG, Koelbl H, Espuna-Pons M, Milsom I, Tubaro A, Wagg A, Vierhout ME. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn 2010; 29:30-9. [PMID: 20025017 DOI: 10.1002/nau.20858] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS In this review we try to shed light on the following questions: *How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? *Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? *What is the possible pathophysiology of OAB in POP? *Do OAB symptoms and DO change after conservative or surgical treatment of POP? METHODS We searched on Medline and Embase for relevant studies. We only included studies in which actual data about OAB symptoms were available. All data for prolapse surgery were without the results of concomitant stress urinary incontinence (SUI) surgery. RESULTS Community- and hospital-based studies showed that the prevalence of OAB symptoms was greater in patients with POP than without POP. No evidence was found for a relationship between the compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP (surgery, pessaries) resulted in an improvement in OAB symptoms. It is unclear what predicts whether OAB symptoms disappear or not. When there is concomitant DO and POP, following POP surgery DO disappear in a proportion of the patients. Bladder outlet obstruction is likely to be the most important mechanism by which POP induces OAB symptoms and DO signs. However, several other mechanisms might also play a role. CONCLUSIONS There are strong indications that there is a causal relationship between OAB and POP.
Collapse
Affiliation(s)
- T A de Boer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hermieu JF. Bilan urodynamique et prolapsus. Prog Urol 2009; 19:970-4. [DOI: 10.1016/j.purol.2009.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 09/17/2009] [Indexed: 11/26/2022]
|
16
|
Liang CC, Tseng LH, Chang SD, Chang YL, Lo TS. Resolution of elevated postvoid residual volumes after correction of severe pelvic organ prolapse. Int Urogynecol J 2008; 19:1261-6. [PMID: 18461269 DOI: 10.1007/s00192-008-0619-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 03/19/2008] [Indexed: 11/25/2022]
Abstract
We hypothesized that elevated postvoid residual volume (PVRV) would resolve postoperatively in women with severe pelvic organ prolapse (POP) and investigated risk factors that might hamper its resolution. Retrospectively, we enrolled 57 patients undergoing surgery for severe POP. All patients had preoperative PVRV > or = 100 ml documented by ultrasound and catheterization. Presurgical voiding difficulty, urodynamic and cystoscopic data, and surgical outcome were analyzed. The incidence of postsurgical elevated PVRV was 15.8% and 3.5% was symptomatic. Patients with postsurgical elevated PVRV had larger preoperative residual volume than those with normal postsurgical PVRV (P = 0.037). By multivariable analysis, concomitant anti-incontinence surgery was the single independent predictor of postsurgical elevated PVRV (odds ratio = 5.38, P = 0.031). A majority of patients with severe POP had their elevated PVRV resolved postoperatively. Although concomitant anti-incontinence surgery increased the risk of developing elevated PVRV after repair, most remained asymptomatic.
Collapse
Affiliation(s)
- Ching-Chung Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, Republic of China.
| | | | | | | | | |
Collapse
|
17
|
Nygaard I, Kreder K, Mueller E, Brubaker L, Goode P, Visco A, Weber AM, Cundiff G, Wei J. Does urethral competence affect urodynamic voiding parameters in women with prolapse? Neurourol Urodyn 2008; 26:1030-5. [PMID: 17638306 DOI: 10.1002/nau.20436] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To (1) compare voiding parameters and (2) correlate symptoms and urodynamic findings in women with pelvic organ prolapse (POP) and varying degrees of urethral competence. METHODS We compared three groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the Colpopexy and Urinary Reduction Efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI) during prolapse reduction. Group 3 participants (n = 74), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms and planned sacrocolpopexy. Participants completed standardized uroflowmetry, pressure voiding studies, and validated symptom questionnaires. RESULTS Subjects' median age was 61 years, median parity 3 and 87% had stage III or IV POP. Fourteen percent of women in Group 3 demonstrated USI without, and 70% with, prolapse reduction. Women in Groups 2 and 3 had more detrusor overactivity (DO) than Group 1 (17 and 24% vs. 6%, P = 0.02) and detrusor overactivity incontinence (DOI) (15 and 8% vs. 0%, P = 0.004). Based on the Blaivis-Groutz nomogram, 60% of all women were obstructed. Post-void residual volume (PVR), peak flow rate, detrusor pressure at peak flow, voiding mechanisms, voiding patterns, obstruction and urinary retention did not differ among groups. Women in Group 3 had higher irritative and obstructive symptom scores than Group 1 or 2; neither score differed by presence of DO nor obstruction, respectively. CONCLUSION Women with POP have significant rates of urodynamic obstruction and retention, independent of their continence status. Symptoms of obstruction and retention correlate poorly with urodynamic findings.
Collapse
Affiliation(s)
- Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah College of Medicine, Salt Lake City, UT 84132, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, Zyczynski H, Brown MB, Weber AM. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J 2008; 19:607-14. [PMID: 18185903 DOI: 10.1007/s00192-007-0498-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study is to describe results of reduction testing in stress-continent women undergoing sacrocolpopexy and to estimate whether stress leakage during urodynamic testing with prolapse reduction predicts postoperative stress incontinence. Three hundred twenty-two stress-continent women with stages II-IV prolapse underwent standardized urodynamics. Five prolapse reduction methods were tested: two at each site and both performed for each subject. Clinicians were masked to urodynamic results. At sacrocolpopexy, participants were randomized to Burch colposuspension or no Burch (control). P-values were computed by two-tailed Fisher's exact test or t-test. Preoperatively, only 12 of 313 (3.7%) subjects demonstrated urodynamic stress incontinence (USI) without prolapse reduction. More women leaked after the second method than after the first (22% vs. 16%; p = 0.012). Preoperative detection of USI with prolapse reduction at 300ml was pessary, 6% (5 of 88); manual, 16% (19 of 122); forceps, 21% (21 of 98); swab, 20% (32 of 158); and speculum, 30% (35 of 118). Women who demonstrated preoperative USI during prolapse reduction were more likely to report postoperative stress incontinence, regardless of concomitant colposuspension (controls 58% vs. 38% (p = 0.04) and Burch 32% vs. 21% (p = 0.19)). In stress-continent women undergoing sacrocolpopexy, few women demonstrated USI without prolapse reduction. Detection rates of USI with prolapse reduction varied significantly by reduction method. Preoperative USI leakage during reduction testing is associated with a higher risk for postoperative stress incontinence at 3 months. Future research is warranted in this patient population to evaluate other treatment options to refine predictions and further reduce the risk of postoperative stress incontinence.
Collapse
Affiliation(s)
- Anthony G Visco
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, P.O. Box 3192, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Burgio KL, Nygaard IE, Richter HE, Brubaker L, Gutman RE, Leng W, Wei J, Weber AM. Bladder symptoms 1 year after abdominal sacrocolpopexy with and without Burch colposuspension in women without preoperative stress incontinence symptoms. Am J Obstet Gynecol 2007; 197:647.e1-6. [PMID: 18060965 DOI: 10.1016/j.ajog.2007.08.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 06/02/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to examine changes in bladder symptoms 1 year after abdominal sacrocolpopexy (ASC) with vs without Burch colposuspension. STUDY DESIGN Women without stress urinary incontinence (SUI) symptoms undergoing ASC were randomized to receive or not receive Burch. One year later, irritative, obstructive, and SUI symptoms were assessed in 305 women using Urogenital Distress Inventory subscales. A composite "stress endpoint" combined SUI symptoms, positive stress test, and retreatment. RESULTS In all women, the mean irritative score decreased from 19.6 +/- 16.3 (mean +/- SD) to 9.1 +/- 10.6; for obstructive symptoms, from 34.8 +/- 21.0 to 6.3 +/- 10.4 (both P < .001). Preoperative bothersome irritative symptoms resolved in 74.6% (126 of 169) and obstructive symptoms in 85.1% (212 of 249), independent of Burch. Fewer women with Burch had urge incontinence (14.5% vs 26.8%, P = .048) and fulfilled the stress endpoint (25.0% vs 40.1%, P = .012). CONCLUSION ASC reduced bothersome irritative and obstructive symptoms. Prophylactic Burch reduced stress and urge incontinence.
Collapse
|
20
|
Abstract
This paper outlines the presentation, evaluation, and management of bladder outlet obstruction (BOO) in women as it relates to iatrogenic, anatomic, and neurogenic causes. Attention is given to the different diagnostic criteria used by various authors in their case series and studies. The lack of standardization with regard to the diagnosis of BOO in women emphasizes the fact that BOO is often a clinical diagnosis that is made by taking into account the history, physical examination, imaging of the lower urinary tract, and urodynamic pressure-flow parameters. Individual obstructive conditions including urethral stricture, postsurgical obstruction, primary bladder neck obstruction, pelvic organ prolapse, and neurogenic causes are addressed briefly.
Collapse
Affiliation(s)
- Rebecca J McCrery
- Scott Department of Urology, 6560 Fannin,Suite 2100, Houston, TX 77030, USA.
| | | |
Collapse
|
21
|
Pelvic organ prolapse and the lower urinary tract: The relationship of vaginal prolapse to stress urinary incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2006. [DOI: 10.1007/s11884-006-0003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
22
|
Cole EE, Kaufman MR, Scarpero HM, Dmochowski RR. The effects of isolated posterior compartment defects on lower urinary tract symptoms and urodynamic findings. BJU Int 2006; 97:1024-6. [PMID: 16643484 DOI: 10.1111/j.1464-410x.2006.06130.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine any significant patterns among subjective and/or objective storage or voiding variables in women with isolated rectoceles or posterior enteroceles. PATIENTS AND METHODS We retrospectively reviewed the charts of 23 women with isolated posterior compartment defects. Patient histories, physical examination findings, catheterized postvoid residual urine volume (PVR) after uroflowmetry, and urodynamic evaluations were reviewed. Lower urinary tract symptoms (LUTS) were classed as pure storage (urgency, frequency, nocturia, etc.), pure voiding (hesitancy, straining, positional voiding, etc.), or mixed. RESULTS The mean (range) age of the women was 67 (48-85) years. On physical examination, 15 women had a grade 3 defect, and eight a grade 2 defect. Thirteen women reported symptoms related to their prolapse (vaginal bulge, splinting with defecation): nine reported pure storage symptoms, one pure voiding symptoms, and 12 mixed symptoms; two women relied on catheterization for bladder emptying. Only one woman reported no LUTS. An elevated PVR (>100 mL) was found in 11 women (48%). Urodynamic studies were available for 17 women, and revealed detrusor overactivity in nine of them. There were low maximum urinary flow rates (Qmax < or = 15 mL/s) in 12 of the 17 women, and high voiding pressures at Qmax (P(det.Qmax) > or = 20 cmH2O) in 10. Both findings were present in seven of the 17 women. There was evidence of abdominal straining to void in nine of the 17 women. CONCLUSIONS The overwhelming majority of women with isolated posterior compartment defects reported bothersome LUTS and most had abnormal urodynamic variables. The findings suggest that significant posterior prolapse defects can cause bladder outlet obstruction.
Collapse
Affiliation(s)
- Emily E Cole
- Urologic Surgery, Vanderbilt University, Nashville, TN, USA.
| | | | | | | |
Collapse
|
23
|
Gilleran JP, Lemack GE, Zimmern PE. Reduction of moderate-to-large cystocele during urodynamic evaluation using a vaginal gauze pack: 8-year experience. BJU Int 2006; 97:292-5. [PMID: 16430632 DOI: 10.1111/j.1464-410x.2005.05905.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effect of cystocele reduction by a vaginal gauze pack on urodynamic studies (UDS). PATIENTS AND METHODS UDS from consecutive women with symptomatic pelvic organ prolapse were reviewed. The protocol included a 'fill-void' study with a vaginal gauze pack, and then repeated without the pack. Tracings were categorized based on filling cystometrograms (CMGs) and pressure-flow studies (PFS). RESULTS Of 202 women, 121 with a mean (sd) age of 67 (9.4) years contributed 221 interpretable 'pack, then no-pack' UDS (111 CMGs and 110 PFS); 77 of the women had a moderate cystocele and 44 had a large cystocele. Eighty-five women had urethral hypermobility (UH), and 36 had a well-supported urethra (WSU). The pack unmasked stress urinary incontinence (SUI) in 6% of women, with a mean (sd, range) Valsalva leak-point pressure of 54 (22, 23-90) cmH(2)O. SUI occurred more often in women with UH than WSU. Detrusor overactivity occurred similarly in pack (15%) and no-pack (14%) tracings. Bladder outlet obstruction (BOO) was relieved by the pack in 25 studies and caused by the pack in four. Women with WSU had BOO more often than those with UH (43% vs 22%, P < 0.05), regardless of the presence or absence of the pack. CONCLUSION Unmasked SUI by pack reduction was uncommon, presumably due to anterior vaginal wall stabilization, as the pack rarely caused BOO. Those with SUI had Valsalva leak-point pressures suggestive of intrinsic sphincter deficiency. The pack did not significantly influence the presence of detrusor overactivity.
Collapse
Affiliation(s)
- Jason P Gilleran
- University of Texas, Southwestern Medical Center, Urology, Dallas, TX 75390, USA
| | | | | |
Collapse
|
24
|
Smith PP, Appell RA. Pelvic organ prolapse and the lower urinary tract: the relationship of vaginal prolapse to stress urinary incontinence. Curr Urol Rep 2005; 6:340-7. [PMID: 16120234 DOI: 10.1007/s11934-005-0050-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Vaginal prolapse and urinary incontinence frequently coexist. Rather than having a cause-and-effect relationship, these two common problems share etiologic factors. Specific tissue and functional deficiencies resulting in prolapse also are significant contributors to lower urinary tract symptoms, particularly stress urinary incontinence. This article reviews this relationship, the etiologic factors, and aspects of the clinical evaluation of the patient with prolapse and stress urinary incontinence.
Collapse
Affiliation(s)
- Phillip P Smith
- Scott Department of Urology, Scurlock 2100, 6560 Fannin Avenue, Houston TX 77030, USA.
| | | |
Collapse
|
25
|
|
26
|
Abstract
PURPOSE Prolapse is the protrusion of a pelvic organ beyond its normal anatomical confines. It represents the failure of fibromuscular supports. MATERIALS AND METHODS A MEDLINE search was done using the keywords cystocele, uterine prolapse, vault prolapse, enterocele or rectocele in combination with urinary incontinence. We reviewed 97 articles. From this material the definition, classification, incidence, symptoms and evaluation are described. RESULTS Prolapse and urinary incontinence often occur concomitantly and cystocele, rectocele, enterocele, uterine descent or vaginal vault prolapse may also be present. The pathophysiology of prolapse encompasses direct and indirect injury, metabolic abnormalities and chronic high intra-abdominal pressure. Anterior vaginal wall prolapse may present as stress incontinence. A large cystocele may cause urethral kinking and overflow incontinence. Uterine descent can cause lower back and sacral pain. Enterocele may cause only vague symptoms of vaginal discomfort. A rectocele can lead to incomplete evacuation of stool. A thorough history and physical examination are the most important means of assessment. A voiding diary helps determine functional bladder capacity. Uroflow examination determines the average and maximum flow rates, and the shape of the curve can help identify Valsalva augmented voiding. Multichannel urodynamics or video-urodynamics with prolapse reduced can be important. The advantages of dynamic magnetic resonance imaging include excellent depiction of the soft tissues and pelvic organs, and their fluid content during various degrees of pelvic strain. To our knowledge whether it is cost-effective in this manner has not been determined. CONCLUSIONS Correction of prolapse must aim to restore vaginal function and any concomitant urinary incontinence.
Collapse
|
27
|
Brubaker L, Cundiff G, Fine P, Nygaard I, Richter H, Visco A, Zyczynski H, Brown MB, Weber A. A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods. ACTA ACUST UNITED AC 2003; 24:629-42. [PMID: 14500059 DOI: 10.1016/s0197-2456(03)00073-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The primary aim of this randomized clinical trial is to evaluate whether a standardized modified Burch colposuspension, when added to planned abdominal sacrocolpopexy for the treatment of pelvic organ prolapse, improves the rate of urinary stress continence in subjects without preoperative symptoms of stress urinary incontinence. Secondary aims include comparison of immediate and short-term complications, overall urinary tract function, and other aspects of pelvic health between subjects with and without a concomitant Burch. The value of preoperative urodynamic testing with prolapse reduction will also be compared between subjects with and without a concomitant Burch. This trial is performed through the Pelvic Floor Disorders Network, which is funded by the National Institutes of Health-National Institute of Child Health and Human Development. Subjects will be enrolled at seven clinical centers across the United States and data will be analyzed by the central data coordinating center. Standardized questionnaires and physical observations and measurements will be obtained. The surgical team is masked to the preoperative urodynamic findings, and the patient and research coordinator are masked to treatment assignment. The primary outcome will be determined at 3 months after surgery. Stress continence is defined as absence of stress incontinence symptoms by questionnaire, a negative standardized stress test, and no treatment for stress incontinence other than the study intervention. Additional follow-up occurs at 6, 12, and 24 months. Accrual began in April 2002 and is projected to take 3 years. As of March 6, 2003, 91 patients have been randomized. This article highlights the scientific aspects of trial design for this pivotal clinical trial. The optimal approach to the urinary tract in women treated surgically for prolapse is not known. This trial is designed to provide pelvic surgeons and their patients with scientific data regarding the utility of urodynamics with and without prolapse reduction and the role of colposuspension with sacrocolpopexy.
Collapse
Affiliation(s)
- Linda Brubaker
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Numbers of women seeking consultation for pelvic floor disorders, a large portion of which will involve pelvic organ prolapse (POP) and lower urinary tract dysfunction, are expected to reach epidemic proportions within the next decade. A full understanding of the complex impact of pelvic organ prolapse on lower urinary tract function is crucial to successful management. RECENT FINDINGS Recent data lend support to the concept that women with POP, but no associated urethral dysfunction, may be best served by a surgical repair that carefully avoids dissection in the periurethral area. Conversely, preoperative evaluation will often reveal bladder outlet obstruction concomitant with 'hidden', 'potential', or 'occult' stress urinary incontinence when the prolapse is reduced. Many of these women will not have incontinence symptoms in daily life. Paradoxically, the mechanical bladder outlet obstruction may induce detrusor instability with subsequent obstructed/overactive bladder symptom complexes not dissimilar to those of men with prostatic bladder outlet obstruction. Anatomic research shows that the vessels and nerves supplying the urethra are particulary vulnerable to surgical techniques used in pelvic organ prolapse repair. SUMMARY This mix of obstructed, overactive bladder with hidden stress incontinence increases with degree of POP, and all women with severe prolapse will fair best if evaluated for all three conditions prior to surgical repair.
Collapse
Affiliation(s)
- Lauri J Romanzi
- Obstetrics and Gynecology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA.
| |
Collapse
|
29
|
|
30
|
NGUYEN JOHNK, BHATIA NARENDERN. RESOLUTION OF MOTOR URGE INCONTINENCE AFTER SURGICAL REPAIR OF PELVIC ORGAN PROLAPSE. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65547-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- JOHN K. NGUYEN
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Harbor-University of California-Los Angeles Medical Center, University of California-Los Angeles School of Medicine, Los Angeles, California
| | - NARENDER N. BHATIA
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Harbor-University of California-Los Angeles Medical Center, University of California-Los Angeles School of Medicine, Los Angeles, California
| |
Collapse
|
31
|
Weber AM. Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence? Obstet Gynecol Surv 2001; 56:720-35. [PMID: 11711907 DOI: 10.1097/00006254-200111000-00024] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urethral pressure profilometry is commonly used as a diagnostic test for stress urinary incontinence. The objective of this article is to review the published literature on urethral pressure profilometry to summarize its usefulness. MEDLINE was used to search the published English literature from 1966 to October 2000 for full-length original research articles on urethral pressure profilometry and stress urinary incontinence in women. Terms related to urethral pressure profilometry are defined consistently but techniques are not standardized, introducing variation in test results. Reproducibility of urethral pressure profilometry parameters is poor, both because of biological variation and variation within the test procedure itself (related in part to lack of standardization). Parameters of urethral pressure profilometry do not distinguish between continent and incontinent women and do not characterize the severity of incontinence or urethral incompetence. It is, therefore, concluded that urethral pressure profilometry is not a useful diagnostic test for stress urinary incontinence in women. Its use in clinical management is not supported by current evidence.
Collapse
Affiliation(s)
- A M Weber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh, PA 15213, USA.
| |
Collapse
|
32
|
Fitzgerald MP, Kulkarni N, Fenner D. Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol 2000; 183:1361-3; discussion 1363-4. [PMID: 11120497 DOI: 10.1067/mob.2000.110956] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether surgery for advanced pelvic organ prolapse corrects the voiding dysfunction commonly associated with this condition and if so to evaluate the ability of preoperative voiding studies to predict such correction. STUDY DESIGN We reviewed the records of all women who underwent surgery at our center between January 1996 and June 1999 for stage 3 or 4 pelvic organ prolapse. Patients were included in this review if they had a postvoid residual volume of >100 mL documented by catheterization on at least 2 occasions, had no normal postvoid residual volumes documented, and had undergone preoperative multichannel urodynamic testing that included an instrumented voiding study. Demographic and urodynamic data were analyzed for the ability to predict whether the elevated postvoid residual volume would be resolved after surgery. RESULTS Thirty-five patients satisfied the criteria for inclusion in the review. Twenty-six had stage 3 pelvic organ prolapse and 9 had stage 4 pelvic organ prolapse. The mean preoperative postvoid residual volume was 226 mL (range, 105-600 mL). Thirty-one patients (89%) had normal postvoid residual volumes after surgery. As a predictor of elevated postoperative postvoid residual volumes, the preoperative voiding study (performed with the prolapse reduced) had a sensitivity of 66%, a specificity of 46%, a positive predictive value of 12%, and a negative predictive value of 93%. CONCLUSION In our center a preoperative voiding study performed with the pelvic organ prolapse reduced most accurately predicted postoperative voiding function when results of the voiding study were normal. Most patients with advanced pelvic organ prolapse and elevated postvoid residual volume had normalization of the postvoid residual volume after surgical correction of the pelvic organ prolapse.
Collapse
Affiliation(s)
- M P Fitzgerald
- Department of Obstetrics and Gynecology, Section of Urogynecology and Pelvic Reconstructive Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA
| | | | | |
Collapse
|
33
|
Abstract
Mixed symptomatology, i.e. both stress and urge incontinence, is reported by patients, either of their own accord or in response to a questionnaire. Our understanding of motor urge incontinence, detrusor instability, stress incontinence and sensory urge incontinence is changing. Detrusor instability is now known to be a urodynamic observation of uncertain clinical significance. Symptoms reported by patients are not equivalent to a urodynamic diagnosis but the problem seems to be more in the urodynamics than in the symptoms. Evidence shows that sensory urge incontinence and motor urge incontinence are probably gradations of the same condition. The relationship between stress incontinence and an overactive bladder is complex. For example, neither detrusor instability nor urge incontinence appear to adversely influence the outcome of surgical treatment for stress incontinence; however, this treatment does not have a good success rate. At present, it is not clear whether this poor outcome reflects a lack of efficacy of the operations used, or their application to inappropriate patients.
Collapse
Affiliation(s)
- E J McGuire
- Division of Urology, University of Texas Medical School at Houston, Texas, USA
| |
Collapse
|
34
|
Valentini F, Saby MO, Besson G, Nelson P. Incontinence urinaire et cystocèle: intérêt et apport d'un modèle mathématique de la miction. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0168-6054(98)80004-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Veronikis DK, Nichols DH, Wakamatsu MM. The incidence of low-pressure urethra as a function of prolapse-reducing technique in patients with massive pelvic organ prolapse (maximum descent at all vaginal sites). Am J Obstet Gynecol 1997; 177:1305-13; discussion 1313-4. [PMID: 9423729 DOI: 10.1016/s0002-9378(97)70069-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our aims were to compare several prolapse-reducing techniques during urodynamic evaluation and prospectively evaluate their usefulness in identifying the incidence of low urethral closure pressure in continent patients with massive prolapse. STUDY DESIGN This preoperative, prospective, repeated-measures urodynamic study evaluated the maximum urethral closure pressure with the use of four different techniques in 30 consecutive continent patients with grade 4 prolapse at all vaginal sites. Twenty patients with grade 0 prolapse served as the control group. All patients from the prolapse group underwent surgical treatment and were followed up clinically for a minimum of 1 year. RESULTS Use of the Scopette (Birchwood Laboratories, Eden Prairie, Minn.) reduction technique to reduce the prolapse in a linear orientation during multichannel urodynamics revealed a 56% incidence of low-pressure urethra and an overall genuine stress urinary incontinence of 83% in patients with massive pelvic organ prolapse but without clinical urinary incontinence. CONCLUSIONS There may be an increased indication for sling urethropexy in patients with massive prolapse.
Collapse
Affiliation(s)
- D K Veronikis
- Division of Urogynecology and Reconstructive Pelvic Surgery, Vincent Memorial Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | | |
Collapse
|
36
|
Affiliation(s)
- Harvey A. Sauer
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Carl G. Klutke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
37
|
Handa VL, Jensen JK, Ostergard DR. Federal guidelines for the management of urinary incontinence in the United States: Which patients should undergo urodynamic testing? Int Urogynecol J 1995. [DOI: 10.1007/bf01894262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|