Urodynamic factors associated with the large capacity bladder and incomplete emptying after prolapse repair (2009‐2015)

Abstract

Aims To identify the clinical and urodynamic factors associated with the large capacity bladder and incomplete bladder emptying after prolapse repair. Methods We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015. Women were stratified by urodynamic capacity. The primary outcome was incomplete emptying at the longest follow‐up (postvoid residual [PVR] > 200 mL). Data were analyzed in the Statistical Analysis System software. Results Two hundred and sixty‐six women (mean age, 61 years) had preoperative urodynamic tracings available for review. After surgery, there were 519 PVRs in 239 women recorded at up to 2949 days (mean, 396) and nine time points (median, 2; IQR, 1‐3). The receiver operator curve for predicted probability of longest follow‐up PVR greater than 200 mL (area under curve = 0.67) identified the 600 mL cutpoint which defined large capacity bladder. Large capacity bladders (capacity, >600 mL [n=79] vs ≤600 mL, [n=160]) had a mean: detrusor pressure at maximum flow (21 vs 22 cm H2O; P = 0.717), maximum flow rate (19 vs 17 mL/s; P = 0.148), significantly elevated PVR (202 vs 73 mL; P < 0.001), and significantly lower voiding efficiency (VE) (74 vs 82%, P < 0.05). Following prolapse repair, elevated PVR was associated with large capacity (PVR 101 vs 49 mL, P < 0.05). Large bladders had a two‐ to three‐fold risk of longest follow‐up PVR greater than 200 mL (14.3%‐20.3% [capacity, >600 mL] vs 4.1%‐7.0% [capacity, ≤600 mL]). VE was similar after surgery regardless of the capacity (87% vs 88%, P = 0.772). Conclusions The decision to pursue prolapse repair should be individualized and take into account, the bladder capacity and goals for PVR improvement after surgery.

Postoperative Urinary Retention

“…There are numerous studies reporting on the use of preoperative urodynamics to predict postoperative voiding dysfunction and urinary retention 72–76,122,123 . Most studies report that no single urodynamic voiding parameter accurately predicts POUR.…”

“…[1][2][3][4][117][118][119] Several studies have shown the rate of POUR after isolated MUS is less than when the MUS is placed at the time of prolapse repair, The only preoperative urodynamic parameter that is predictive of a successful VT is a Q max > 30 mL/s and conversely a failed VT is associated with a preoperative maximal flow rate <15 mL/s. [72][73][74][75][76][77] 87.50…”

“…There are numerous studies reporting on the use of preoperative urodynamics to predict postoperative voiding dysfunction and urinary retention. [72][73][74][75][76]122,123 Most studies report that no single urodynamic voiding parameter accurately predicts POUR. However, a published abstract of a systematic review of MUS clinical trials from 1989 to 2010 identified 3 "good quality" studies that reported preoperative urodynamics and the status of the postoperative VT. 77 The authors found that a preoperative maximum flow rate of more than 30 mL/s was predictive of passing a VT, and a preoperative maximum flow rate of less than 15 mL/s was predictive of failure.…”

Comparative Study Between Bladder Diary and Urodynamic Study to Identify Lower Urinary Tract Symptoms

“…A 2020 study pointed out that DO patients have lower bladder capacity, ranging from 240 to 280 mL 21 . Another study evaluated UDS of patients submitted to surgical repair of pelvic organ prolapse and observed increased bladder capacity (greater than 600 mL) associated with incomplete emptying 27 .…”

Estudo Comparativo Entre Diário Vesical E Estudo Urodinâmico Para Identificação De Sintomas Do Trato Urinário Inferior

“…Um estudo de 2020 apontou que pacientes com HD apresentam menor capacidade vesical, variando de 240 a 280 mL21 . Outro estudo avaliou EU de pacientes submetidos a reparo cirúrgico de prolapsos de órgãos pélvicos e observaram capacidade vesical aumentada (superior a 600 mL) associada a esvaziamento incompleto27 .As diretrizes para boas práticas para realização do EU, publicadas pela ICS em 2018, indicam o preenchimento do DV por três dias antes da realização do exame como parte do protocolo8 . A capacidade preditiva indicada neste estudo e a superioridade na detecção de STUI apontam para a possibilidade de o DV ser utilizado de forma isolada para definição de primeira linha de tratamento, e não apenas como uma preparação para o EU.Uma publicação recente comparou a satisfação de mulheres tratadas com base nos achados de EU e mulheres tratadas com base em um questionário de avaliação de impacto da incontinência urinária.…”