Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Abstract

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann–Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67–8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03–1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85–2.38) and defect type (p = 0.02, B – 1.42, 95% CI – 2.65 to – 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.

Evaluation of the clinical effectiveness of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse: A feasibility report based on 50 patients

“…These symptoms may be due to the urethra being obstructed preoperatively due to the severe prolapse of the organ, which has squeezed and distorted the urethra. Some patients also present with insidious stress incontinence, which gradually becomes apparent after pelvic floor reconstruction due to a change in the urethral angle ( 24 , 25 ). In this study, two new cases of lower urinary tract symptoms of varying degrees were found in the T4 group during the postoperative follow-up period, while no new symptoms were found in the mSSLF group.…”