Prolapse reduction deteriorates the urethral closure mechanism
- 56 Downloads
Introduction and hypothesis
Pelvic organ prolapse (POP) reduction is often performed in the preoperative assessment of women before POP surgery. Using urethral pressure reflectometry (UPR), we sought to investigate how POP reduction affects the urethral closure mechanism.
Women with anterior or posterior vaginal wall prolapse stage ≥II with and without POP reduction were examined with a speculum. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest and during squeezing, and standardized stress tests with 300 ml saline. All examinations were repeated after insertion of a speculum.
We included 38 women: 22 with anterior and 16 with posterior vaginal wall prolapse POP-Q stage ≥II. During POP reduction, resting and squeezing urethral pressures decreased by 2.5 cmH2O (p = 0.007) and 5.1 cmH2O (p < 0.0001), respectively, in all women. During POP reduction, the number of positive stress tests increased from four (18%) to eight (36%) in women with anterior vaginal wall prolapse and from one (6%) to nine (56%) in women with posterior vaginal wall prolapse.
POP reduction decreases urethral pressure, especially during squeezing, and consequently increases the number of positive stress tests. The test itself artificially deteriorates the urethral closure mechanism.
KeywordsPelvic organ prolapse Urinary stress incontinence Urethral pressure reflectometry Urodynamics
We thank Nurse Berit Sejersen Larsen for her assistance with all examinations in this study.
The study was fully funded by the University of Copenhagen, as part of a PhD Scholarship. The University of Copenhagen had no part in the study.
Compliance with ethical standards
Conflicts of interest
Y.K., G.L. and N.K. have received honoraria as investigators from Astellas. G.L. has also been a consultant for Contura.
- 8.Khayyami Y, Lose G, Klarskov N. Urethral pressure reflectometry in women with pelvic organ prolapse: a study of reproducibility. Int Urogynecol J. 2016; https://doi.org/10.1007/s00192-016-3187-1.
- 10.Khayyami Y, Klarskov N, Lose G. The promise of urethral pressure reflectometry: an update. Int Urogynecol J. 2016; https://doi.org/10.1007/s00192-016-2964-1.
- 11.Khayyami Y, Lose G, Klarskov N. The urethral closure mechanism is deteriorated after anterior colporrhaphy. Int Urogynecol J. 2017; https://doi.org/10.1007/s00192-017-3504-3.
- 12.Khayyami Y, Lose G, Klarskov N. Posterior colporrhaphy does not affect the urethral closure mechanism. Int Urogynecol J. 2017; https://doi.org/10.1007/s00192-017-3401-9.
- 13.Haylen BT, Maher CF, Barber MD, et al. An international urogynecological association (IUGA) / international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27:165–94. https://doi.org/10.1007/s00192-015-2932-1.CrossRefPubMedGoogle Scholar
- 14.Schäfer W. Some biomechanical aspects of continence function. Scand J Urol Nephrol Suppl. 2001;207:44–60.Google Scholar
- 16.Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and urinary reduction efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14. https://doi.org/10.1007/s00192-007-0498-2.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5:CD005654Google Scholar
- 21.van der Ploeg J, Oude Rengerink K, van der Steen A, et al. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG Int J Obstet Gynaecol. 2015;122:1022–30. https://doi.org/10.1111/1471-0528.13325.CrossRefGoogle Scholar
- 22.van der Ploeg J, van der Steen A, Oude Rengerink K, et al. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG Int J Obstet Gynaecol. 2014;121:537–47. https://doi.org/10.1111/1471-0528.12509.CrossRefGoogle Scholar
- 25.Saaby M-L, Klarskov N, Lose G. Urethral pressure reflectometry during intra-abdominal pressure increase—an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women. Neurourol Urodyn. 2013;32:1103–8. https://doi.org/10.1002/nau.22368.CrossRefPubMedGoogle Scholar