Lower urinary tract function improves after laparoscopic sacrocolpopexy for elderly patients with pelvic organ prolapse

Abstract

Objectives Pelvic organ prolapse (POP) is relatively common in the elderly population. Laparoscopic sacrocolpopexy (LSC) has been reported by several studies to be a less invasive treatment option as compared to open sacrocolpopexy. However, almost all prior reports focused on the complications or surgical obstacles. The present study was designed to examine POP patients of all ages and assess lower urinary tract function before and after LSC. Methods This retrospective study examined the results of LSC performed in POP patients. Urodynamic studies were performed pre‐ and postoperatively in 50 patients, with the subjects divided into two groups containing those less than and those older than 65 years of age. We performed a pressure flow study. We examined bladder functions by evaluating bladder capacity, detrusor pressure at maximum flow (PdetQmax), maximum flow rate (Qmax), normal desire to void, strong desire to void, voided volume, and postvoid residual volume (PVR). Statistical analysis was performed using Wilcoxon signed rank test. Values of P < .05 were considered significant. Results With regard to the pressure‐flow study parameters, there was a significant increase in the normal desire to void and bladder capacity only in the ≥65 age group. After the operation, there was a significant increase in the mean postoperative Qmax and voided volume, while there was a significant decrease in the PdetQmax and PVR as compared to the preoperative values only in the ≥65 age group. Conclusions Results show that in elderly patients with POP, LSC might be a valid option with regard to potentially regaining urinary tract function.

Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse

“…11 Regardless of the presence of SUI, our group has examined the changes in preoperative and postoperative MUCP in patients who underwent LSC, and there were no significant differences between pre-and postoperative MUCP. 15,16 In this study, we found no statistical difference between pre-and postoperative MUCP in both the de novo SUI-positive and SUI-negative groups. Similar results were obtained in a study of patients who underwent colporrhaphy and transvaginal mesh surgery.…”

“…Regardless of the presence of SUI, our group has shown that there were no significant differences between pre-and postoperative values of urethral function in patients who underwent LSC. 15,16 To explore the predictors of de novo SUI after LSC, this study compared the preoperative urodynamic features between the de novo SUI-negative and SUI-positive groups. Furthermore, to investigate the association between the changes of UDS parameters and de novo SUI, this study examined whether there are differences in UDS parameters before and after LSC.…”

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

“…A multicentre prospective study involving women with grade !2 symptomatic POP who underwent surgery demonstrated a significant reduction in voiding symptoms and PVR volume at 1 yr after surgery [69]. A retrospective study of women who underwent laparoscopic sacrocolpopexy for POP showed a significant increase in mean postoperative Q max and decreases in P det -Q max and PVR volume in those aged !65 yr [70].…”

Novel insight into the correlation between hernia orifice of cystocele and lower urinary tract function: a pilot study

“…Moreover, another review stated that women with high-grade POP have increased urethral closure pressure and pressure/ transmission ratios, which decreases after the prolapse is reduced by surgery. Thus, the definitive aim of prolapse surgery is to reduce or eliminate the PVR in conjunction with its accompanying contribution to the VD diagnosis [3]. Advanced POP may cause changes in the voiding function, therefore resulting in a variety of urinary symptoms, such as urinary leakage and obstructive voiding [13].…”

“…Moreover, cystocele is the most commonly seen among all of the conditions associated with POP. High-grade cystocele is generally associated with lower urinary tract dysfunction, such as voiding dysfunction (VD) and stress urinary incontinence (SUI) [2,3]. However, the mechanism of lower urinary tract dysfunction due to cystocele has yet to be fully understood.…”