Available online 10 November 2023

Author links open overlay panel, , , , , AbstractStudy Objective

To determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO).

Design

Retrospective cohort study

Setting

Tertiary Referral Hospital

Patients

One thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO

Interventions

Pelvic Reconstructive Surgery

Measurements

The primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS.

Main Results

Total of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml.

Conclusion

Voiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.

Section snippetsINTRODUCTION

Voiding behavior in women with pelvic organ prolapse (POP) may be altered after Pelvic Reconstructive surgery (PRS) with various study reports on resumption of normal voiding function1-3. Unfortunately, Voiding Dysfunction (VD) may persist despite successful restoration of pelvic structures.

Voiding dysfunction can be attributed to detrusor underactivity (DU) and bladder outlet obstruction (BOO)4. Obstructive symptoms in women with POP may occur as a result of urethral kinking, leading to

MATERIALS AND METHODS

This is a retrospective study performed in a tertiary referral center. The medical records of 1894 patients who underwent PRS for advanced POP from January 2006 to January 2022 were reviewed, after obtaining institutional review board approval (IRB: 202300247B0). Patients with clinically confirmed POP-Q stage III-IV and urodynamic findings of BOO were included. Exclusion criteria were patients with VD symptoms without BOO on urodynamic studies (UDS), neurogenic bladder dysfunction, and

RESULTS

Out of 1894 women with advanced POP, 433 women had UDS diagnosis of BOO. Among them, 431 (22.8%) were included in the study. Patients were excluded following incomplete pre- or post- operative data, as well as negative urodynamic diagnosis of BOO. All patients included in the study were pre-operatively with POP-Q Stage III and IV, with Qmax ≤15 ml/s and PdetQmax of ≥20cm H20 (Fig. 1)

Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have VD 1

DISCUSSION

Anticipation of resumption of normal voiding function following PRS in POP patients is expected, with most patients remaining cured following years after surgery. However, there are minority of patients that remain to have VD despite anatomical successful prolapse repair. While most studies reported on the success of normal voiding function following prolapse surgery, little explored on the population that remains with VD. While about 1.1 % patients are expected to develop de novo VD after

CONCLUSION

Voiding Dysfunction may persist in women with bladder outlet obstruction following pelvic organ prolapse repair surgery, particularly in those with pre-operative maximal cystometric capacity of >500ml and post-void residual volume > 200ml. Thus, it is worthwhile to counsel patient on possibility of persistent voiding dysfunction following pelvic reconstructive surgery.

References

1. Lo TS, Shailaja N, Hsieh WC, Uy-Patrimonio MC, Yusoff FM, Ibrahim R. Predictors of voiding dysfunction following extensive vaginal pelvic reconstructive surgery. Int Urogynecol J. 2017;28(4):575-582.

2. Espuna Pons M, Cassado J, Diez Itza I, Valero Fernandez EM. Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study. Actas Urol Esp (Engl Ed). 2021;45(1):57-63.

3. Aichner S, Fahnle I, Frey J, Krebs J,

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© 2023 Published by Elsevier Inc. on behalf of AAGL.