Abstract
Objective
To assess whether specific changes in bladder neck morphology, caused by an anterior
repair operation, are associated with resolution of overactive bladder and improved
urinary flow rates.
Study design
Sixty-four women with urgency documented on the urgency perception scale (UPS) underwent
an anterior repair. Their preoperative flow studies were compared to those 8 weeks
postoperatively. Flow rates were compared in those women who reported improved or
cured urgency to those who reported no effect. Resolution of urgency was correlated
with the change in bladder neck angulation (posterior urethrovesical angle-PUA).
Results
55% (35/64) women reported no urgency after the anterior repair. A further 19% (12/64)
were improved and 26% (17/64) were no better. Patients who were cured or improved
showed a significant increase in their flow rates after surgery (mean flow = 15 before and 17.6 ml/s after) (Mann–Whitney p = 0.04). There was a significant change (increase in the PUA angle/straightening of
the angle between the bladder and urethra) from a mean value of 123 degrees (SD 49.3)
preoperatively to a mean value of 146.8 (SD 29.2) post operatively (p < 0.001). Despite an increase in PUA, this was not correlated with an increase in the
maximum flow rate centile (p = 0.45, r = 0.10).
Conclusions
An anterior repair results in increased maximum urinary flow rates but this does not
correlate to changes in the appearance of the bladder neck.
Keywords
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References
- Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery.Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21: 1143-1149
- The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population.Int Urogynecol J Pelvic Floor Dysfunct. 2011; 22: 569-575
- Prevalence of symptomatic pelvic organ prolapse in a Swedish population.Int Urogynecol J Pelvic Floor Dysfunct. 2005; 6: 497-503
- Predictors of improved overactive bladder symptoms after transvaginal mesh respire for the treatment of pelvic organ prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2011; 22: 535-542
- Pelvic organ prolapse and overactive bladder.Neurourol Urodyn. 2010; 29: 30-39
- A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse.Am J Obstet Gynecol. 2007; 197: e1-e4
- Do overactive bladder symptoms improve after repair of anterior wall prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1439-1443
- Effect of prolapse repair on voiding and overactive bladder.Curr Opin Obstet Gynecol. 2010; 22: 399-403
- Effect of prolapse repair on voiding and the relationship to overactive bladder and detrusor overactivity.Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 499-504
- The association of changes in opening detrusor pressure with the resolution of overactive bladder symptoms after repair of pelvic organ prolapse.Neurourol Urodyn. 2011; 30: 595-598
- Does levator ani injury affect cystocele type.Ultrasound Obstet Gynecol. 2010; 36: 618-623
- Validation of the urgency perception scale.BJU Int. 2005; 95: 591-596
- Female pelvic organ prolapse and voiding function.Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13: 284-288
- Bladder outlet obstruction in women: definition and characteristics.Neurourol Urodyn. 2000; 19: 213-220
- Does neuromuscular blockade affect the assessment of pelvic organ prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2012; 23: 1599-1603
- Ultrasound changes in the relationship between the urethra and bladder neck caused by prolapse repair: feasibility and reliability of measurements.J Obstet Gynaecol. 2012; 32: 672-675
- Updated recommendations on ultrasound in urogynecology.Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 236-241
- Sample size tables for clinical studies.Blackwell, Oxford1997
- An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21: 5-26
- Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms and provided care.BMC Womens Health. 2009; 9: 9
- A prospective study to evaluate the antomical and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair.J Minim Invas Gynecol. 2008; 15: 615-620
- Resolution of elevated post-void residual volumes after correction of severe pelvic organ prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1261-1266
- Impact of prolift procedure on bladder function and symptoms in women with pelvic organ prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2011; 22: 585-590
- Urgency resolution following prolapse surgery: is voiding important.Int Urogynecol J Pelvic Floor Dysfunct. 2013; 24: 1309-1313
- Identification of the optimal time to treat urgency after a midurethral sling procedure for stress urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 573-576
Article info
Publication history
Published online: September 30, 2013
Accepted:
September 15,
2013
Received in revised form:
June 27,
2013
Received:
May 8,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
