The effect of bladder fullness on evaluation of pelvic organ prolapse (original) (raw)
Related papers
Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms
International Journal of Gynecology & Obstetrics, 2010
Objective: To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction. Methods: We reviewed preoperative data from patients with advanced POP who underwent surgical correction at Obstructive voiding symptoms were recorded from Pelvic Floor Distress Inventory-20 questionnaires. Results: Of the 81 women aged 44-80 years who were included in the study, 40 (49.4%) reported incomplete bladder emptying preoperatively. There was no significant difference between these women and asymptomatic women in terms of demographic and clinical parameters such as age, parity, and stage of prolapse. Furthermore, there was no significant difference with regard to postvoid residual bladder volume (52.8 ± 65.8 vs 41.6 ± 41.2 mL), maximal (23.8 ± 11 vs 21.9 ± 9.6 mL/second) and average (10.3 ± 6.2 vs 9.3 ± 4 mL/second) urinary flow velocities, prevalence of increased postvoid residual volume (10.0% vs 4.8%), or obstructive urinary flow (17.5% vs 7.3%). Conclusion: Almost half of all women with advanced POP experienced incomplete bladder emptying; however, this symptom did not correlate with objective urodynamic bladder outflow tract obstruction.
Nepal Journal of Obstetrics and Gynaecology, 2014
Aims: This was performed to examine pelvic organ prolapse using POP-Q technique and correlate pre-existing urinary symptoms with segments of pelvic organ prolapse. Methods: All patients admitted with pelvic organ prolapse were included. Patients were asked regarding any concomitant urinary symptoms and then all patients were examined by POP-Q technique and correlation of urinary symptoms was done with various segments of pelvic organ prolapse. Results: Eighty patients were studied in one year duration. Majority of patients had presented with stage 4 prolapse (58.8%). Majority of patients had urinary symptoms among which 87.5% had increased urinary frequency, 88.8% had dysuria, 65% had stress urinary incontinence (SUI), 72.5% had incomplete evacuation. Dysuria and SUI was found to have significant correlation with anterior segment prolapse (p<0.05%). Conclusions: Site specific measurements by POP-Q system showed anterior segment prolapse to be more and were significantly associate...
Neurourology and Urodynamics, 2008
Aims: To (1) correlate peak and maximum flow rates from non-instrumented flow (NIF) and pressure-flow studies (PFS) in women with pelvic organ prolapse (POP); (2) measure the impact of voided volume and degree of prolapse on correlations. Methods: We compared four groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the colpopexy and urinary reduction efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n ¼ 67) did not have and Group 2 (n ¼ 84) had urodynamic stress incontinence (USI). Group 3 (n ¼ 74) and Group 4 participants (n ¼ 73), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms. Group 3 planned sacrocolpopexy. Group 4 planned a different treatment option. Participants completed standardized uroflowmetry and pressure voiding studies. Results: Subjects' median age was 61 years; median parity 3% and 80% had stage III or IV POP. Based on the Blaivas-Groutz nomogram, 49% of all women were obstructed. NIF and PFS peak and average flow rates had low correlations with one another (0.31, P < 0.001 and 0.35, P < 0.001, respectively). When NIF and PFS voided volumes were within 25% of each other, the peak and average flow rate correlations improved (0.52, P < 0.001 and 0.57, P < 0.001, respectively). As vaginal prolapse increased, correlations between NIF and PFS peak and average flow rates decreased. Conclusion: Peak and average flow rates are highly dependent on voided volume in women with prolapse. As the prolapse stage increases, correlations between NIF and PFS variables decrease. Neurourol.
International Urogynecology Journal, 2013
Introduction and hypothesis To evaluate the relationship between pelvic organ prolapse (POP) staging and clinical findings, lower urinary tract symptoms (LUTS), sexual dysfunction, and quality of life (QoL) using validated questionnaires. Methods Women attending the urogynecology unit with LUTS and/or bulging (n=388) were grouped according to the POP quantification (POPQ). LUTS, sexual dysfunction, and QoL were evaluated using the Urinary Distress Inventory-6 (UDI-6),the Overactive Bladder Awareness tool (OAB-V8), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the Incontinence Impact Questionnaire-7 (IIQ-7). Data regarding baseline characteristics, clinical findings, and scores of questionnaires were compared among the POP stages using the Kruskal-Wallis test. Pearson's and Spearman's correlation analyses were used to evaluate the correlation of POP staging with clinical findings, pelvic floor dysfunction related symptom severity, and QoL. Results According to the POPQ, patients were classified as: stage 0 (27.8 %), stage 1 (21.4 %), stage 2 (38.9 %), and stages 3 and 4 (11.8 %). Irritative, stress, obstructive subscale scores of UDI-6 and physical, travel, emotional subscale scores of IIQ-7 were significantly different among POPQ stages. Weak correlations between POPQ staging and irritative, stress, obstructive subscale scores of r=0.192, and r=0.146 respectively), and physical, travel, social, emotional subscale scores of IIQ-7 (r=0.223, r=0.154, r=120 and r=0.171 respectively) were found (p<0.05). Clinical findings (Q-tip and stress test positivity, post-void residual volumes) showed moderate to weak correlations with POPQ stages (r=0.425, r=0.117, r=0.163 respectively; p<0.05). Conclusions The correlation of lower urinary tract dysfunction and POP staging was shown to be best represented by UDI-6 and IIQ-7.
International Urogynecology Journal, 2011
Introduction and hypothesis The objective of this study is to determine the association between the POPQ and a simplified version of the POPQ. Methods This was an observational study. The subjects with pelvic floor disorder symptoms underwent two exams: a POPQ exam and a simplified POPQ. To compare with the simplified POPQ, vaginal segments of the POPQ exam were defined using points Ba, Bp, C, and D. Primary outcome was the association between the overall ordinal stages from each exam. Results One hundred forty-three subjects with mean age of 56 +/− 13 years. Twenty three subjects were status posthysterectomy. The Kendall's tau-b statistic for overall stage was 0.80, for the anterior vaginal wall the Kendall's tau-b was 0.71, for the posterior vaginal wall segment the Kendall's tau-b was 0.71, for the cervix the Kendall's tau-b was 0.88, for the posterior fornix/vaginal cuff the Kendall's tau-b was 0.85. Conclusions There is substantial association between the POPQ and a simplified version of the POPQ.
IP Innovative Publication Pvt. Ltd, 2017
Background: The commonly used methods of classifying or grading for the pelvic organ prolapse are qualitative and subjective with high interobserver and intraobserver variations. This absence of standardization prevents meaningful comparisons of the published series, surgical results, effective communications among clinicians and longitudinal comparison in an individual case. Aim of this study was to determine the association between the standardized pelvic organ prolapse quantification system (POP Q) and Shaw's system of classification of pelvic organ prolapse. Materials and Methods: This was an observational study in which 100 cases of pelvic organ prolapse, whose average age was 47+/-10 years, underwent two system of examinations-POP Q System and Shaws's system of classification at Sardar Vallabh Bhai Patel hospital associated with Lala Lajpat Rai Memorial Medical College Meerut by five gynaecologists by randomization of the patients, without knowing findings of each other during a period of June 2015 to July 2016. Weighted Kappa statistics was used to compare the data. It is a qualitative test. Results: The weighted Kappa statistics was used for the intersystem association and reliability of the Shaw's classification system compared with standard POP Q system were 0.784 for the overall stage:0.782 and 0.68 for anterior and posterior compartment respectively; 0.86.for central compartment. Conclusion: There was strong intersystem association seen between the Shaws system and POP Q system of classification of pelvic organ prolapse.
International Urogynecology Journal, 2019
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 (Q max) 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.
Does urethral competence affect urodynamic voiding parameters in women with prolapse?
Neurourology and Urodynamics, 2007
Aims: To (1) compare voiding parameters and (2) correlate symptoms and urodynamic findings in women with pelvic organ prolapse (POP) and varying degrees of urethral competence. Methods: We compared three groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the Colpopexy and Urinary Reduction Efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n ¼ 67) did not have and Group 2 (n ¼ 84) had urodynamic stress incontinence (USI) during prolapse reduction. Group 3 participants (n ¼ 74), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms and planned sacrocolpopexy. Participants completed standardized uroflowmetry, pressure voiding studies, and validated symptom questionnaires. Results: Subjects' median age was 61 years, median parity 3 and 87% had stage III or IV POP. Fourteen percent of women in Group 3 demonstrated USI without, and 70% with, prolapse reduction. Women in Groups 2 and 3 had more detrusor overactivity (DO) than Group 1 (17 and 24% vs. 6%, P ¼ 0.02) and detrusor overactivity incontinence (DOI) (15 and 8% vs. 0%, P ¼ 0.004). Based on the Blaivis-Groutz nomogram, 60% of all women were obstructed. Post-void residual volume (PVR), peak flow rate, detrusor pressure at peak flow, voiding mechanisms, voiding patterns, obstruction and urinary retention did not differ among groups. Women in Group 3 had higher irritative and obstructive symptom scores than Group 1 or 2; neither score differed by presence of DO nor obstruction, respectively. Conclusion: Women with POP have significant rates of urodynamic obstruction and retention, independent of their continence status. Symptoms of obstruction and retention correlate poorly with urodynamic findings.
Impact of preoperative urodynamics on women undergoing pelvic organ prolapse surgery
International Urogynecology Journal, 2019
Introduction and hypothesis Preoperative urodynamic studies (UDS) are frequently performed before pelvic organ prolapse (POP) surgery to assess urethral and bladder function. The primary goal of this study is to examine how preoperative UDS are utilized and what value these studies have in patient treatment and/or counseling. Methods We retrospectively reviewed patients who underwent prolapse surgery and had preoperative UDS between June 2010 and February 2015. Indications for UDS were classified into four categories: (1) occult stress urinary incontinence only, (2) overactive bladder symptoms, (3) mixed or insensible urinary incontinence, and (4) voiding symptoms and/or elevated post-void residual. We identified changes in management or counseling that were directly attributable to UDS results prior to surgery. Results Three hundred ninety-two patients underwent urodynamic testing for indications 2-4 above, and 316 met the inclusion criteria. Fifty-seven percent (180/316) had OAB symptoms (34.4% wet, 65.6% dry), 40.2% (127/316) had mixed incontinence, and 17.1% (54/316) had voiding symptoms and/or elevated PVR. A total of 3.5% (11/316) patients had alteration in their management or counseling based on the results of the UDS; 29.4% (50/170) of the women evaluated for occult SUI alone or with other symptoms demonstrated it and 41 underwent sling placement. Conclusions UDS did not have a significant impact on preoperative management or counseling in POP surgery if demonstration of occult SUI was not the indication for preoperative study in women committed to POP surgery. Major alterations in treatment were rare and occurred mostly in women with stress incontinence that also had concomitant voiding symptoms and/or elevated PVR.
Use of pelvic organ prolapse staging systems in published articles of selected specialized journals
International Urogynecology Journal, 2010
Introduction and hypothesis A standardized system for reporting pelvic organ prolapse is important for clinical communication, patient follow-up, and meaningful comparisons between studies. In 1996, the description of the Pelvic Organ Prolapse Quantification system (POPQ) was published. We hypothesized that its use in published articles of specialized journals would increase over time. Methods Articles from eight journals in 2004 and 2007 were included if any attempt to grade prolapse was mentioned. Reviews, editorials, and abstracts were excluded. Results Use of POPQ increased from 64.9% to 82.1% (p=0.01) while other systems decreased. POPQ was used more frequently in the US than other countries. Urologists used POPQ less and Baden-Walker more frequently than other specialists. Conclusions Use of POPQ has increased in the period studied. This trend was observed in all the subgroups analyzed, showing that POPQ is being adopted as the universal language of prolapse in the published literature.