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The impact of pelvic organ prolapse surgery on bladder function: comparison of three surgical approaches
IUGA Academy. Padoa A. Jun 30, 2018; 212899
Topic: Pelvic Organ Prolapse
Dr. Anna Padoa
Dr. Anna Padoa

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379

The impact of pelvic organ prolapse surgery on bladder function: comparison of three surgical approaches

Padoa, A1; Tsviban, A1; Hassouna, H1; Smorgick, N1

1: Yitzhak Shamir Medical Center

Introduction: Epidemiological studies suggest overactive bladder (OAB) is more common in pelvic organ prolapse (POP) patients, with a relative risk of 2.1-5.8. Stress urinary incontinence (SUI) is found in up to 55 % of women with POP. To date, few studies have addressed the impact of different POP repair approaches on lower urinary tract symptoms (LUTS).

Objective: This longitudinal cohort study compares the impact of surgery for advanced prolapse on LUTS. Surgical approaches included: Sacrospinous fixation (SSF) and colporrhaphy (group 1), single-incision mesh repair with Elevateä (group 2) and robotic sacrocolpopexy (group 3). The primary outcome was the incidence of urgency urinary incontinence (UUI) and SUI 6-18 months after surgery. The secondary outcome was the predictive value of urodynamics for post-operative urinary urgency.

Methods: Between November 2012 and July 2017, patients eligible for POP surgery for stage 3 and 4 prolapse were recruited. Pre-operative evaluation included a symptom questionnaire, POP-Q and the PFDI-20 questionnaire. Conventional urodynamic studies were done in patients with LUTS. Vaginal procedures were performed by a single surgeon. Right sacrospinous fixation was done using either Capioä or DigitexÒ. Elevateä was performed following manufacturer instructions. Robotic sacrocolpopexy was carried out by a team including a urogynecologist and an endoscopic surgeon. Post-operative follow-up was scheduled at 6-18 months.

Results: 165 patients were recruited. Patients who returned for follow-up at 6-18 months were included in data analysis: 62 patients in group 1, 31 patients in the group 2 and 31 patients in the group 3. Patients in group 3 were younger and had lower parity. POP-Q measurements were higher in group 2 and 3. A vaginal hysterectomy vas carried out in 85.5% of group 1 and in 77.4% of group 2. A supracervical hysterectomy was performed in 71% of group 3. Rates for concomitant TVT were similar between groups (group 1: 56%, group 2: 58% and group 3: 54.8%). The outcome of surgery on LUTS was assessed at 12 months (range: 6-18 months, mean= 11.8 months). Subjective outcome regarding bladder function was assessed through PFDI-20: a positive reply to question 16 was considered positive for UUI and a positive reply to question 17 for SUI. At follow-up, patients in group 3 had less UUI than patients in group 1 and 2: 22.6% in group 1, 12.9% in group 2 and 3.2% in group 3 (p=0.046). De-novo SUI was more common in group 2: 16.1%, as compared to 1.6% in group 1 and 0% in group 3 (p=0.003). Of the 74 patients with pre-operative urinary urgency, urgency was present in 28.6% of patients without pre-operative DO and in 52.2% of patients with pre-operative DO (p=0.039).

Conclusions: Sacrocolpopexy may involve a lower risk of post-operative UUI than vaginal surgery. Vaginal mesh surgery is related to a higher risk of de novo SUI. Pre-operative DO is a risk factor for post-operative urinary urgency.

References:

Curr Opin Obstet Gynecol. 2010 Oct;22(5):399-403.

Int Urogynecol J. 2013 Nov;24(11):1843-52.

Disclosure:

Work supported by industry: no.

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