The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms

Abstract

Introduction and hypothesis To evaluate whether nocturia and coexisting pelvic floor symptoms in women with pelvic organ prolapse (POP) can be improved by ligamentous fixation of apical vaginal prolapse to the sacrospinous ligament. Methods We evaluated the PROPEL study data from 281 women with pelvic organ prolapse stage > 2. Bothersome nocturia and coexisting pelvic floor symptoms were assessed with the Pelvic Floor Disorder Inventory (PFDI) questionnaire preoperatively and at 6, 12 and 24 months after successful vaginal prolapse repair. Women with successful reconstruction (POP-Q stage < 1 at all compartments throughout the 2-year follow-up), defined as anatomical "responders," were compared to the anatomical "nonresponders." Results Among the patients completing all PFDI questions (N = 277), anatomical responders and non-responders were the groups of interest for our analysis. We found the occurrence rates of "moderate" or "quite a bit" of nocturia was significantly reduced after surgery in all subgroups (48.7% at baseline vs. 19.5% after 24 months). The occurrence of nocturia was halved for responders compared to non-responders (45.4% and 48.3% at baseline vs. 14% and 29.5% after 24 months). Anatomical nonresponders still had a relevant improvement of POP-Q stages, especially in the apical compartment. Prevalence rates of coexisting over-and underactive bladder, fecal incontinence, defecation disorders and pain symptoms were also significantly reduced postoperatively. Conclusion Nocturia can be associated with symptomatic POP, with improvements seen following vaginal ligamentous prolapse repair. We caution providers, however, when advising patients of the possible resolution of nocturia following POP reconstruction, that all other traditional etiologies of nocturia must first be ruled out.

Non-Hunner’s Interstitial Cystitis Is Different from Hunner’s Interstitial Cystitis and May Be Curable by Uterosacral Ligament Repair

“…1) are a concise summary of the PFS continuum: bladder/bowel/pain symptoms extend upward to encompass types of prolapse caused by USL laxity, enterocele, uterine/apical prolapse. Surgical data from Tables 3 and 4 and previously [12][13][14][15][16][17][18][19][20] show high cure rates for all PFS symptoms, posterior zone (Fig. 1).…”

“…Collective results of cure of CPP and OAB symptoms [12][13][14][15][16][17][18][19][20][21] and Table 3 support the pathogenesis of CPP from afferent visceral plexus (VP) axons, which, being unsupported because of weak USLs, fire off afferent impulses when stimulated by gravity or muscle movement [9], Figures 3 and 4. These impulses are interpreted by the brain as pain.…”

An anatomical pathogenesis of lower urinary tract definitions from the 2002 ICS report symptoms, conditions, syndromes, urodynamics

“…Surgical cure/improvement in OAB and other PFS symptoms, Figure 4, by PUL or USL sling repair, mainly in post-menopausal women, 3,4,7,8,10,12,13,30,[40][41][42][43][44][45][46][47][48][49] validated with pre and sometimes postoperative urodynamics, is consistent with restoration of the ligament-based peripheral control mechanisms, Figure 1. However, a key paper by Shkarupa et al shows that at least as regards OAB and prolapse, native cardinal/uterosacral ligament repair may give good cure rates at 18 months, but only for premenopausal women, (postmenopausal in brackets) 49 : prolapse:79.6% (16.7); frequency 60% (14.6); urgency 67.3% (16.7); and nocturia 87.7% (18.8).…”

Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study

“…The sleep domain improved after surgery as in a study by Ghetti et al [ 41 ]. This improvement is probably because of the improvement in bladder symptoms such as nocturia as well as improvement in depressive symptoms which occurs after surgery [ 41 , 45 , 48 , 49 ]. As was reported in other studies from the developed world [ 5 , 7 , 50 ], sexual function improved after surgery.…”