Role of urodynamics in evaluation of lower urinary tract dysfunction in women of pelvic organ prolapse
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20203858Keywords:
Detrusor overactivity, Lower urinary tract dysfunction, Stress urinary incontinence, Urodynamic study, Utero-vaginal prolapseAbstract
Background: Utero-vaginal prolapse is a common gynecological disorder, result from weakness of musculoskeletal structure that support the pelvic organ. Although it is not an emergency situation but severely affect the quality of life. Women with utero-vaginal prolapse may present with lower urinary tract dysfunction but association of urological changes with UV prolapse and beneficial effect of surgery on these changes is still debatable. Urodynamic study such as cystometry and uroflowmetry help in better understanding of lower urinary tract dysfunction and assist to plan appropriate surgical management thereby reduce chances of postoperative voiding dysfunction.
Methods: A total of 30 women of pelvic organ prolapse with lower urinary tract dysfunction, over a period of one year, were subjected to urodynamic studies after thorough evaluation by history, examination and standardized questionnaire both pre and post operatively and data analysed.
Results: In present study, urodynamic study identified urinary dysfunction in 93.34% of women recruited in study. Obstruction was present in 36.67% of women. Detrusor overactivity along with obstruction was seen in 20.00% of women. Urodynamic stress incontinence and urodynamic stress incontinence along with obstruction was identified in 13.33% of women each and detrusor overactivity was observed in 10.00% of women.
Conclusions: In present study it was found that, if surgical management of pelvic organ prolapse is planned according to urodynamic study, it will improve urologic profile of patients. To conclude that urodynamic study should be an integral part of diagnostic work up of uterovaginal prolapse patients require larger sample size and at least 6 months follow-up duration after surgery.
References
Gurel H, Gurel SA. Pelvic relaxation and associated risk factors: the result of logistic regression analysis. Acta Obstet Gynecol Scand.1999;78:290-3.
Swift SE, Pound T, Dias JK. Case control study in the etiologic factors in the development of severe pelvic organ prolapsed. In Urogyenecol J Pelvic Floor Dysfunct. 2001;12:87-192.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic-organ prolapse and urinary incontinence... Obstet Gynecol.1997;89(4):501.
Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford family planning association study. Br J Obstet Gynaecol. 1997;104:579-85.
Chiaffarino F, Chatenoud L, Dindelli M, Meschia M, Buonaquidi A, Amiacarelli F, et al. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol. 1999;82:63-7.
Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynaecol. 1996;88:470-8.
Bump R, Mattiasson A, Bo K, Brubakar LP, DeLancy JO, Klarskov P, et al. The standardization of terminology of female pelvic prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10-7.
Barber MD, Matthew D. Symptoms and outcome measures of pelvic organ prolapse. Clin Obstet Gynecol J. 2005;48(3):684-61.
Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. Br J Obstet Gynecol. 2005;112(7):971-6.
Brading AF, Turner WH. The unstable bladder: towards a comman mechanism. Br J Urol. 1994;73(1):3-8.
Costanini E, Mearini E, Pajoncini C, Biscotto S, Bini V, Porena M. Uroflowmetry in female voiding disturbances. Neurourol Urodyn. 2003;22:569-73.
Hubeaux K, Deffieux X, Jousse M, Amarenco G. Correlation between voiding dysfunction symptoms and uroflowmetry in women suffering from stress urinary incontinence. Indian J Urol. 2012;28(3):313-7.
Swift SE, Pound T, Dias JK. Case control study in the etiological factors in the development of severe pelvic organ prolapsed. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:87-192.
Hendrix SL, Clark A, Nygaard I, Argaki A, Barnabei V, Mc Tiernan A. Pelvic organ prolapse in the women’s health initiative: gravity and gravidiy. Am J Obstet Gynecol. 2002;186(6):1160-6.
Jha S, Toozs-Hobson P, Parson M, Gull F. Does preoperative urodynamics changes the management of prolapse? J Obs Gynecol. 2008;28(3):320-2.
Thorn BS, Brown JS. Reproductive and hormonal risk factors for urinary incontinence in later life. A review of clinical and epidemiological literature. J Amer Geriatr Soc. 1998;46:1411-7.
Liang CC, Chang SD, Chang YL, Tseng LH, Lo TS, Soong YK. Postsurgical urinary incontinence in continent women undergoing hysterectomy for uterine prolapse. Incont Pelvic Floor Dysfunct. 2007;2:45-8.
Klutke JJ, Ramos S. Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol. 2000;182:1378-1.
Rosenweig BA, Pushkin S, Blumenfeld D, Bhatia NN. Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse. Obstet Gynecol. 1992;79:539-42.
Duecy EE, Pulvino JQ, Mcnanley AR, Buchsbaum GM. Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes. Female Pelvic Med Reconstr Surg. 2010;16:215-7.
Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti- incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163:531-4.
Nguyen JK, Bhatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166:2263-6.
Stanton SL, Hilton P, Norton C, Cardozo L. Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinence. Br J Obstet Gynecol. 1982;89:459-63.