Managing the Urethra at Transvaginal Pelvic Organ Prolapse Repair: A Urodynamic Approach
- 28 February 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 181 (2), 679-684
- https://doi.org/10.1016/j.juro.2008.10.009
Abstract
Purpose: We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair. Materials and Methods: A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction. Results: The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%. Conclusions: Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.Keywords
This publication has 19 references indexed in Scilit:
- Re: Reevaluating Occult Stress IncontinenceEuropean Urology, 2006
- Abdominal Sacrocolpopexy with Burch Colposuspension to Reduce Urinary Stress IncontinenceThe New England Journal of Medicine, 2006
- Pessary Test to Predict Postoperative Urinary Incontinence in Women Undergoing Hysterectomy for ProlapseObstetrics & Gynecology, 2004
- Combined genital prolapse repair reinforced with a polypropylene mesh and tension‐free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case–control study with short‐term follow‐upActa Obstetricia et Gynecologica Scandinavica, 2004
- Relationship between Stress Urinary Incontinence and Pelvic Organ ProlapseInternational Urogynecology Journal, 2002
- PREDICTING THE NEED FOR ANTI-INCONTINENCE SURGERY IN CONTINENT WOMEN UNDERGOING REPAIR OF SEVERE UROGENITAL PROLAPSEJournal of Urology, 2000
- Epidemiology of surgically managed pelvic organ prolapse and urinary incontinenceObstetrics & Gynecology, 1997
- Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapseAmerican Journal of Obstetrics and Gynecology, 1988
- The effect of uterovaginal prolapse on urethrovesical pressure dynamicsAmerican Journal of Obstetrics and Gynecology, 1983
- Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinenceBJOG: An International Journal of Obstetrics and Gynaecology, 1982