The correlation of voiding variables between non‐instrumented uroflowmetery and pressure‐flow studies in women with pelvic organ prolapse

Wei, John T.; Nygaard, Ingrid; Brubaker, Linda; Varner, Ed; Visco, Anthony G.; Cundiff, Geoffrey W.; Weber, Anne M.; Ghetti, Chiara; Kreder, Karl J.

doi:10.1002/nau.20568

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…In POP patients with anterior compartment prolapse, the MUFR, AUFR, and MBV were all signi cantly decreased, the voiding time was clearly prolonged, and the PVR was increased. This is consistent with the report of Mueller E et al 22 . Bladder wall hypertrophy, hypoxia, detrusor irritability, and upregulation of spinal re exes, which are resulted from the bladder outlet obstruction (BOO) is the pathophysiology of bladder voiding and storage symptoms.…”

Section: Discussionsupporting

confidence: 94%

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

Xia

et al. 2020

Preprint

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This retrospective cohort study aims to explore the clinical value of urodynamics in evaluating lower urinary tract function in pelvic organ prolapse (POP) patients, and to investigate the urodynamic characteristics of POP patients with occult stress urinary incontinence (OSUI) in whom moderate or above postoperative SUI eventually occurred after prolapse surgery. The medical records of 626 advanced POP patients who underwent vaginal pelvic reconstructive surgery were analyzed. The patients with anterior compartment prolapse were more susceptible to urodynamic changes than those with apical or posterior compartment prolapse (95.1% vs. 40.15%). The proportion of patients with urodynamic abnormality was increased with prolapse severity (68.8% vs. 78.6%). After 3 months, the incidence of moderate or severe postoperative urinary incontinence in the OSUI patients was 20%, while it is 2.8% in non-OSUI patients. In subgroup analysis of OSUI patients, the urodynamics of patients with moderate or above postoperative urinary leakage showed significantly lower Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), maximal bladder volume (MBV) and maximum urine flow rate (MUFR). For POP patients with OSUI, anti-incontinence surgery is only recommended for whom with lower VLPP, MUCP, MBV and MUFR to avoid the risk and costs of secondary surgery or overtreatment.

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Section: Discussionsupporting

confidence: 94%

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

Xia

et al. 2020

Preprint

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“…One study [ 46 ] examined the correlation between free-flow and pressure-flow studies. It concluded that the peak and average flow rates in women with POP are dependent on voided volume and the correlation between free-flow and pressure-flow studies decreases as the prolapse stage increases.…”

Section: Resultsmentioning

confidence: 99%

“…Assessment of voiding difficulty in women with prolapse was addressed in 11 papers. Six papers had voiding difficulty as the focus [44][45][46][47][48][49] , 4 papers addressed voiding difficulty as part of LUTS assessment [50][51][52][53], and 1 paper addressed the accuracy of ultrasound in measuring bladder volume [54]. Six themes were identified in these studies.…”

Section: Assessment Of Voiding Dysfunction In Women With Popmentioning

confidence: 99%

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Barbier,

Carberry,

Karjalainen

et al. 2023

Int Urogynecol J

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Introduction and hypothesis This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. Methods An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. Results The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. Conclusions The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.

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“…The linear regression equation of the colpopexy and urinary reduction efforts (CARE) data in Figure 3 were taken from a prospective supplementary analysis to the NIH/NICHD's Pelvic Floor Disorders Network (PFDN) CARE trial. 10 The CARE trial enrolled women without the symptoms of SUI undergoing sacrocolpopexy for POP with the primary aim of determining if adding a Burch colposuspension at the time of prolapse surgery would reduce symptoms of stress incontinence. The prospective supplementary study included 298 women with stages II-IV POP, divided into four groups.…”

Section: Graphical Representation Of the Difference In Nif And Pfs Q mentioning

confidence: 99%

Comparison of flowrates and voided volumes during non-instrumented uroflowmetry and pressure-flow studies in women with stress incontinence

Litman

Rickey

Sirls

et al. 2014

Neurourol. Urodynam.

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Aims The Blaivas-Groutz nomogram defines voiding obstruction in women using Qmax from the NIF and the maximum detrusor pressure (Pdetmax) from the PFS. The aim of this study was to understand the relationship between NIF and PFS maximum flow rates in women with stress incontinence. Methods We analyzed the UDS of 597 women with stress-dominant urinary incontinence. Each subject underwent a NIF and then a PFS. Mixed model was used to test the hypothesis that the relationship between flow rates and voided volume were similar for NIF and PFS. Results There were 452 subjects with both NIF and PFS studies that met the inclusion criteria and had max flow rate (Qmax) for both NIF and PFS. The mean age was 53. Overall, higher voided volumes were observed during PFS compared to NIF and subjects had higher Qmax with NIF compared to PFS. The relationship between Qmax and VV was significantly different between NIF and PFS (p < 0.004). At 200 mL, NIF Qmax was 14% higher than PFS Qmax and this difference increased to 30% at 700mL. Conclusion The difference between PFS Qmax and NIF Qmax increases as voided volumes increase. As a result, values from PFS and NIF cannot be used interchangeably as has been suggested in the Blaivas-Groutz nomogram for obstruction in women.

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The correlation of voiding variables between non‐instrumented uroflowmetery and pressure‐flow studies in women with pelvic organ prolapse

Abstract: Peak and average flow rates are highly dependent on voided volume in women with prolapse. As the prolapse stage increases, correlations between NIF and PFS variables decrease.

Cited by 7 publications

References 24 publications

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Comparison of flowrates and voided volumes during non-instrumented uroflowmetry and pressure-flow studies in women with stress incontinence

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