Female Pelvic Organ Prolapse and Voiding Function

Abstract

It is accepted that pelvic organ prolapse impairs voiding, in particular as regards the anterior vaginal wall. The influence of central and posterior prolapse is more controversial. Mechanical effects, i.e. urethral distortion and compression, have been advanced as causative mechanisms. This study attempts to further elucidate the effect of prolapse on voiding. We investigated 228 patients with symptoms of lower urinary tract dysfunction and/or prolapse using independent flowmetry, clinical and ICS prolapse assessment and translabial ultrasound. As expected, age ( P<0.001), previous hysterectomy ( P = 0.002) and/or incontinence surgery ( P<0.001) negatively influenced flow. As regards prolapse, only enterocele had a consistently negative effect on flow ( P<0.001 for clinical staging, P = 0.002 for ICS assessment, P = 0.005 for ultrasound imaging). The relationship between anterior vaginal wall prolapse and voiding was complex: funneling and opening of the retrovesical angle on ultrasound was associated with improved voiding ( P<0.001), but a cystocele with intact retrovesical angle had the opposite effect ( P<0.001).

Changes in connective tissue in patients with pelvic organ prolapse—a review of the current literature

“…Degradation depends upon the combined activity of matrix metalloproteinases (MMP) and their regulation of release, activation or sequestration of growth factors, growth factor (2). The mature, slowly metabolising collagen is susceptible to non-enzymatic cross-linking, also known as glycation or Maillard reaction with the formation of advanced glycation endproducts (3) binding proteins, cell surface receptors and cell-cell adhesion molecules [26].…”

“…It decreases their quality of life considerably [1][2][3]. POP is one of the most common reasons for gynaecological surgery in women after the fertile period.…”

Distribution and immunoexpression of LOX, PCP and Myofi broblasts in Vaginal Tissue of Postmenopausal Women with and without Pelvic Organ Prolapse

“…Pelvic organ prolapse remains one of the most frequently met indications for gynecological operations since it reduces the quality of life of the patients with this condition [1][2][3].…”

“…Pelvic fl oor dysfunction and the resulting pelvic organ prolapse (POP) remain a global health problem, affecting the quality of life of female patients of all ages [1][2][3]. Prolapse is currently one the most frequently met indications for a gynecological operation, especially during the menopausal and postmenopausal period of life.…”

Evaluation and management of voiding dysfunction after midurethral sling procedures

“…Indeed, most patients with transient postoperative urinary retention resume normal voiding following midurethral sling within 1-2 days of the procedure. Return to normal voiding may be delayed for 1-2 weeks in women with a history of prior or concomitant surgery for SUI or POP (32,33). Behavioral treatment begins by encouraging the patient to create a relaxing environment and taking adequate time for voiding.…”