Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery. Issue 7 (17th April 2018)

• Record Type: Journal Article
• Authors: Lo, Tsia‐Shu; Chua, Sandy; Uy‐Patrimonio, Ma. Clarissa; Kao, Chuan C.; Lin, Chih H.
• Is Part Of: Neurourology and urodynamics. Volume 37:Issue 7(2018:Sep.)
• Page Start: 2242
• Page End: 2248
• Publication Date: 2018-04-17
• Subjects: bladder outlet obstruction -- detrusor underactivity -- pelvic organ prolapse -- voiding function; Urinary organs -- Periodicals; Urodynamics -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1002/nau.23576
• Languages: English
• ISSNs: 0733-2467

Abstract

Abstract : Aim: To determine the impact of vaginal pelvic reconstructive surgery (PRS) on detrusor underactivity (DU) patients having advanced pelvic organ prolapse (POP). Methods: A retrospective study of patients who underwent PRS for advanced POP (POP‐Q ≥ 3) with DU. Data regarding preoperative evaluation, surgical procedure, and post‐operative management were collated. Patients were considered to have DU when detrusor pressure at maximum flow (Pdet Qmax ) was ≤10 cmH2 0 and peak flow rate (Qmax ) of ≤12 mL/s. Post‐operative values more than the cut‐off were considered objectively cured. Subjective cure was defined as having a negative response to UDI‐6 Question 5, "Do you experience difficulty emptying your bladder?" Results: A total of 49 patients were evaluated. Majority of the population were post‐menopausal and multiparous. Preoperatively, 38 patients (75%) had stage III prolapse and 13 patients (26%) had stage IV. Subjective cure rate of DU was 76% (37/49) and objective cure rate was 47% (23/49). Post‐operative DU ( P < 0.001) significantly improved together with patients having normal urodynamic diagnosis ( P < 0.001). Voiding function showed significant increase in Qmax ( P < 0.001) and Pdet Qmax ( P < 0.001) while PVR ( P < 0.001) and cystometric capacity ( P < 0.001) significantly decreased. These findings were observed in 89% (43/49) of patients with post‐void residual urine (PVR) of <200 mL, 63% (31/49) with Qmax > 12 mL/s, and 57% (28/49) with Pdet Qmax >10 cmH2 0. Conclusion: Reversal of short‐term or long‐term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.