Ji Yun Chae1, Gil Young Park2, Jae Heon Kim3, Hyung Jee Kim4, Jae Hyun Bae5, Jeong Gu Lee6, Du Geon Moon1, Mi Mi Oh7. 1. Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea. 2. Korea University, College of Medicine, Republic of Korea. 3. Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Republic of Korea. 4. Department of Urology, Dankook University College of Medicine, Republic of Korea. 5. Korea University Ansan Hospital, Korea University College of Medicine, Republic of Korea. 6. Korea University Anam Hospital, Korea University College of Medicine, Republic of Korea. 7. Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: mamah@hanmail.net.
Abstract
OBJECTIVE: It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system. STUDY DESIGN: The clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15mL/s or postvoid residual urine volume (PVR) above 50mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups. RESULTS: Of 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent (p=0.040), with lower maximal flow rate (p=0.007) and higher PVR (p=0.034). POP-Q stage was significantly higher (p=0.018), and points Aa and Ba were significantly longer (p=0.005 and p=0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR. CONCLUSION: The prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.
OBJECTIVE: It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system. STUDY DESIGN: The clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15mL/s or postvoid residual urine volume (PVR) above 50mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups. RESULTS: Of 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent (p=0.040), with lower maximal flow rate (p=0.007) and higher PVR (p=0.034). POP-Q stage was significantly higher (p=0.018), and points Aa and Ba were significantly longer (p=0.005 and p=0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR. CONCLUSION: The prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.