Authors and affiliations:
Maria Cristina Cesana1, Mario Villa1, Luca Damiani2, Maria Lamanna3, Giulia Scordovillo4, Antonio Pellegrino5.
1 Ostetricia e Ginecologia, Ospedale A. Manzoni, via Dell’Eremo 9/11, 23900 Lecco, Italia
2 Ostetricia e Ginecologia, Ospedale San Leopoldo Mandic, Largo Mandic 1, 23807 Merate,I talia
3 Ostetricia e Ginecologia, Università degli Studi di Milano Bicocca, Milano, Italia
4 Ostetricia e Ginecologia, Università di Napoli, Napoli, italia
Topic: Urodynamics, pelvic organ prolapse
Aim. International Continence Society (ICS) affirms that a complete urodynamic study (UDS) is necessary before pelvic organ prolapse (POP) surgical repair.
However the anatomical distorsion of prolapsed tissues can make UDS more difficult to perform and postoperative bladder function more difficult to predict.
UDS is an invasive exam which causes disconfort.
The aim of this study is to evaluate if complete UDS study (uroflowmetry, cistometry and pressure/flow study (P/Q) is really necessary.
Materials. Patients who underwent surgery for POP≥ II POPQ stadium between January 2015 and December 2016, were included in the study. Patients with vaginal vault repair after hysterectomy were excluded.
All the patients completed a preoperative evaluation including uroflowmetry, post-void residual volume valuation, cistometry and pressure/flow study (P/Q).
Results were analized according to ICS guidelines.
Urinary symptoms before and after surgery were carefully investigated and reported.
Results.106 patients were recruited with a mean follow up of 19 months (DS± 5). Mean age was 63 years (DS ± 10).
All the patients underwent vaginal hysterectomy with MCCall colposuspension. 98 bilateral annessiectomy were perfomed. 100 women underwent cistopexy, 3 posterior vaginal repair.
After discharge only 6 patients were subjected to autocatheterization for a week because of positive postvoid residual.
10 (9%) women had preoperative urodynamic diagnosis of detrusor overactivity (DO), 5 (5%) of stess incontinence (SI), 2 (2%) of potential SI, 30 (28%) of voidal disfunction.
Only 3 (3/10) of the women with preoperative diagnosis of DO riported postoperative urgency, 1 (1/5) ripeted urodynamic study and is scheduled for incontinence surgery with suburetral sling.
7 (7/30) women showed voidal disfunction at postoperative uroflowmetry.
2 patients had de novo urgency, 3 de novo SI.
Conclusions. Urodynamic study is an invasive procedure: the application of vescical and rectal catheters causes discomfort. To mantein catheters in the right position can be difficult in case of severe prolapse and it can decrease the reliability of the diagnosis.
DO in patients with POP is caused by distraction of muscolar fibers and sensitive terminations of the bladder due to anatomical distortion. Postoperative bladder function couldn’t be predict as anatomy is different after surgery.
If we performed a preoperative evaluation including uroflowmetry and a stress test at a bladder filling of 300 mL before and after prolapse reduction (for example with a vaginal pessary) we can have a complete view of bladder function with minimum discomfort for the patient.
Normal lower urinary tract assessment in women: I. Uroflowmetry and post-void residual, pad tests, and bladder diaries. Al Afraa T et al. Int Urogynecol
Normal urodynamic parameters in women: part II--invasive urodynamics. Mahfouz W1, Al Afraa T, Campeau L, Corcos J. Int Urogynecol J. 2012 Mar;23(3):269-77. doi: 10.1007/s00192-011-1585-y. Epub 2011 Oct 20.