Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery

Abstract

Reversal of short-term or long-term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.

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

“…Much of the reported literature on urodynamic nomograms assessing bladder contractility (BCI) and the implications of capacity on outcomes have been reported in men . There are only a handful of publications which have identified the importance of a large capacity bladder and elevated PVR in women undergoing anterior and/or apical POP repair.…”

“…There are only a handful of publications which have identified the importance of a large capacity bladder and elevated PVR in women undergoing anterior and/or apical POP repair. In a retrospective study by Lo et al on urodynamic improvements in detrusor underactivity following prolapse repair (n = 49), the authors found a reduction in cystometric capacity from 449 to 377 ( P < 0.001) after prolapse repair, and advocate early surgical intervention since the duration of obstruction may adversely increase capacity and result in a state of detrusor decompensation . What is not defined by these authors is the actionable PVR threshold upon which mandatory intervention is needed to prevent irreversible bladder decompensation after prolapse repair.…”

“…Much of the reported literature on urodynamic nomograms assessing bladder contractility (BCI) and the implications of capacity on outcomes have been reported in men. [17][18][19][20][21] There are only a handful of publications which have identified the importance of a large capacity bladder and elevated PVR in women undergoing anterior and/or apical POP repair. In a retrospective study by Lo et al on urodynamic improvements in detrusor underactivity following prolapse repair (n = 49), the authors found a reduction in cystometric capacity from 449 to 377 (P < 0.001) after prolapse repair, and advocate early surgical intervention since the duration of obstruction may adversely increase capacity and result in a state of detrusor decompensation.…”

“…Since bladder symptoms are a considerable driver of a patient's decision to pursue prolapse repair, and incomplete bladder emptying is one of the most common lower urinary tract dysfunctions encountered in these patients, preoperative expectations are a major driver of a patient's perception of a successful surgical outcome. As such, urodynamic pressure flow evaluation has been a standard for ascertaining a patient's likelihood of spontaneous void following prolapse repair …”

“…As such, urodynamic pressure flow evaluation has been a standard for ascertaining a patient's likelihood of spontaneous void following prolapse repair. 3 The most commonly cited female obstruction nomogram was published by Blaivas and Groutz, 4 which classified women into three grades of obstruction, based on the voiding detrusor pressure cutpoints of 57 and 107 cm H 2 O for differentiating mild, moderate, and severe obstruction. However additional nomograms have identified much lower pressure cutpoints (20-25 cm H 2 O) than Blaivas and Groutz, 4 and have included the addition of flow cutpoints (11-15 mL/s) and fluoroscopic criteria (Chassagne et al, 5 Nitti et al, 6 Lemack and Zimmern, 7 Defreitas et al 8 ).…”