Abstract
Objectives
Straining to void is the need to make a muscular effort in order to initiate, maintain
or improve the urinary stream, through an increase in abdominal pressure. This pattern
of bladder emptying is frequently observed in women with pelvic organ prolapse causing
urinary obstruction, to overcome the increased resistance to urine flow. However,
frequent increases in abdominal pressure are a risk factor for developing pelvic organ
prolapse, and might play a role in its recurrence after surgery. The aim of this study
was to investigate the role of straining identified at urodynamic study in prolapse
recurrence after surgical repair.
Study design
This was a retrospective study on women submitted to prolapse repair by vaginal hysterectomy
with modified McCall culdoplasty and anterior colporraphy. All patients underwent
a preoperative urodynamic evaluation including a pressure-flow study performed after
prolapse reduction by means of a vaginal pessary; straining was defined by a simultaneous
and similar increase in intravesical and abdominal pressures of at least 10 cmH2O over the baseline during bladder emptying, corresponding to intermittent peaks of
urine flow. Patients were divided into two groups according to the presence or absence
of straining, and they were compared for surgical results at 12 months and for the
rate of anterior or central recurrence over time.
Results
Women with straining (n = 16), compared to women with normal voiding (n = 43), showed
a higher risk of anterior recurrence over time at Kaplan-Meier curves, for both stage
II (p = 0.02) and stage III prolapse (p = 0.02). No difference was seen for central
recurrence during the follow up period. POP-Q staging at 12 months was similar for
the two groups, except for the location of the Aa point which was significantly better
for women without straining (−1.6 ± 0.1 cm vs −0.8 ± 0.3 cm, p = 0.03).
Conclusions
Straining to void identified in preoperative urodynamic study seems to increase the
risk of anterior recurrence after surgical repair of pelvic organ prolapse.
Abbreviations:
POP (pelvic organ prolapse), LUTS (lower urinary tract symptoms), UDS (urodynamic study), VH (vaginal hysterectomy), USL (utero-sacral ligament), MMC (modified McCall culdoplasty), SUI (stress urinary incontinence), POP-Q (POP Quantification System), BMI (body mass index), CRD (chronic respiratory disease), PVR (post-void residual), OAB (overactive bladder), PFMT (pelvic floor muscle training)Keywords
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Article info
Publication history
Published online: February 08, 2023
Accepted:
February 6,
2023
Received in revised form:
February 2,
2023
Received:
January 9,
2023
Identification
Copyright
© 2023 Published by Elsevier B.V.
