International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain

Harvey, Marie-Andrée; Chih, Hui Ju; Geoffrion, Roxana; Amir, Baharak; Bhide, Alka; Miotła, Paweł; Rosier, Peter; Offiah, Ifeoma; Pal, Manidip; Alas, Alexandriah

doi:10.1007/s00192-021-04941-5

Cited by 24 publications

(16 citation statements)

References 149 publications

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“…Urinary symptoms are often found to be concurrent symptoms of POP, with a reported prevalence of more than 50 % [ 32 ]. Storage symptoms, such as urinary frequency and urgency, were equally as prevalent in POP patients as in women without POP.…”

Section: Discussionmentioning

confidence: 99%

De novo urinary incontinence and lower urinary tract symptoms after colpocleisis: A single-center prospective study

Gao,

Lou,

Song

et al. 2024

Heliyon

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Section: Discussionmentioning

confidence: 99%

De novo urinary incontinence and lower urinary tract symptoms after colpocleisis: A single-center prospective study

Gao,

Lou,

Song

et al. 2024

Heliyon

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“…The clinician is then left to determine the relative benefits of using one system over another. In addition, it is recognized that many patients with POP often have pelvic floor comorbidities involving other pelvic/abdominal organ systems [ 1 ]. Choosing how best to use clinical resources to properly investigate these conditions in patients with POP can be confusing.…”

Section: Introductionmentioning

confidence: 99%

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Barbier,

Carberry,

Karjalainen

et al. 2023

Int Urogynecol J

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Introduction and hypothesis This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. Methods An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. Results The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. Conclusions The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.

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“…To date, LUTS with POP are common but inconsistently reported, and there are few data on this relationship's incidence. Obstructive voiding is most frequently associated with POP [9]. Patients with isolated posterior POP should be examined for anorectal or bulging symptoms and LUTS [10].…”

Section: Introductionmentioning

confidence: 99%

“…Nonsurgical approaches are usually chosen first by both clinicians and women. Improvement of symptoms and, for conservative management, minimization of prolapse progression are the main objectives of all treatments [9]. Although the patient's preferences ultimately determine the course of therapy, people with symptomatic POP should be made aware that pessary usage is a feasible nonsurgical alternative.…”

Section: Introductionmentioning

confidence: 99%

Pelvic Organ Prolapse Syndrome and Lower Urinary Tract Symptom Update: What’s New?

et al. 2023

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(1) Background: This narrative review aimed to analyze the epidemiological, clinical, surgical, prognostic, and instrumental aspects of the link between pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), collecting the most recent evidence from the scientific literature. (2) Methods: We matched the terms “pelvic organ prolapse” (POP) and “lower urinary tract symptoms” (LUTS) on the following databases: Pubmed, Embase, Scopus, Google scholar, and Cochrane. We excluded case reports, systematic reviews, articles published in a language other than English, and studies focusing only on a surgical technique. (3) Results: There is a link between POP and LUTS. Bladder outlet obstruction (BOO) would increase variation in bladder structure and function, which could lead to an overactive bladder (OAB). There is no connection between the POP stage and LUTS. Prolapse surgery could modify the symptoms of OAB with improvement or healing. Post-surgical predictive factors of non-improvement of OAB or de novo onset include high BMI, neurological pathologies, age > 65 years, and the severity of symptoms; predictors of emptying disorders are neurological pathologies, BOO, perineal dysfunctions, severity of pre-surgery symptoms, and severe anterior prolapse. Urodynamics should be performed on a specific subset of patients (i.e., stress urinary incontinence, correct surgery planning), (4) Conclusions: Correction of prolapse is the primary treatment for detrusor underactivity and for patients with both POP and OAB.

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International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain

Cited by 24 publications

References 149 publications

De novo urinary incontinence and lower urinary tract symptoms after colpocleisis: A single-center prospective study

De novo urinary incontinence and lower urinary tract symptoms after colpocleisis: A single-center prospective study

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Pelvic Organ Prolapse Syndrome and Lower Urinary Tract Symptom Update: What’s New?

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