Role of Urodynamics in Management of Patients With Pelvic Organ Prolapse

Abstract

Utero-vaginal prolapse (UV) is a common condition affecting millions of women worldwide, and a major cause of gynecological surgery. Although it is not life threatening but, it can have a severe impact on quality of life. Prolapse is a protrusion of a pelvic organs beyond its normal anatomical confines and it represents the failure of fibromuscular support to maintain normal position. Urodynamic Study (UDS) is the dynamic study of the transport, storage and evacuation of urine. The ultimate goal of urodynamics is to aid in the correct diagnosis of urinary incontinence based on pathophysiology. Urodynamic studies assess both the filling storage phase and the voiding phase of the bladder and urethral function. AIM: of this study is to assess the role of urodynamic measures in pelvic organ prolapse (POP) patients for identifying the urinary problems concomitant with prolapse for proper management. The use of urodynamic tests are for diagnosis, prognosis, guidance of clinical management and decision for type of surgery that results in improvement of patient outcomes with various urological conditions. KEYWORDS: With Pelvic Organ Prolapse (POP) Urodynamic Study Urinary Incontinence. INTRODUCTION:Utero-vaginal prolapse (UV) is a common condition affecting millions of women worldwide, and a major cause of gynecological surgery. Although it is not life threatening but, it can have a severe impact on quality of life.Prolapse is a protrusion of a pelvic organs beyond its normal anatomical confines and it represents the failure of fibromuscular support to maintain normal position. (1) Two third of affected women have concominent cystocele and/or rectocele. Cystocele is primarily the result of weakened pubocervical fascia. (2) Women with UV prolapse may present with a wide range of lower urinary tract symptoms. The prolapse may mechanically obstruct the urethra, leading to bladder outlet obstruction, impede voiding and mask urinary incontinence. (3) The pathophysiology of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) are related and can be considered multifactorial. These factors may be divided into intrinsic (Genetic, age, postmenopausal status, ethinicity) and extrinsic components (Parity, history of previous delivery, co-morbidities and patient's occupation). Overall, irrespective of the inciting factor, the end result is the same: an anatomical defect in the endopelvicfascial layer leads to prolapse. The clinical factors involved in prolapse are damage of the soft tissues sustained during pregnancy and weakening of pelvic floor tissue during menopause. (4) Prolapse and urinary incontinence often occur concomitantly. Anterior vaginal wall prolapse may present as stress incontinence. A large cystocele may cause uretheral kinking and overflow incontinence. Uterine descent can cause lower back and sacral pain. Enterocele may cause only vague symptoms of vaginal discomfort. A rectocele can lead to incomplete evacuation of stool. Stress incontinence is described as the involuntary leakage of urin...