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Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse

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Abstract

Introduction and hypothesis

The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II–IV pelvic organ prolapse (POP).

Methods

In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II–IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery.

Results

Median follow- up was 22 months (range 8–48). After surgery, maximum flow (Qmax) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0–45) at baseline to 5.5 (0–17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001).

Conclusions

The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.

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Authors and Affiliations

  1. Andrology and Urogynecological Clinic, Santa Maria Hospital Terni, University of Perugia, Piazzale Tristano di Joanuccio, Terni, Italy

    Ester Illiano & Elisabetta Costantini

  2. Urogynecology Unit, San Carlo di Nancy Hospital, Rome, Italy

    Franca Natale

  3. Urology Clinic,Santa Maria della Misericordia Hospital Perugia, University of Perugia, Piazzale Tristano di Joanuccio, Terni, Italy

    Antonella Giannantoni & Marilena Gubbiotti

  4. AOUI Verona, Urology Clinic, University of Verona, Verona, Italy

    Matteo Balzarro

Authors
  1. Ester Illiano
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  2. Franca Natale
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  3. Antonella Giannantoni
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  4. Marilena Gubbiotti
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  5. Matteo Balzarro
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  6. Elisabetta Costantini
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Correspondence to Elisabetta Costantini.

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Illiano, E., Natale, F., Giannantoni, A. et al. Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse. Int Urogynecol J 30, 589–594 (2019). https://doi.org/10.1007/s00192-019-03874-4

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  • DOI: https://doi.org/10.1007/s00192-019-03874-4

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