Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

Abstract

patients with pelvic organ prolapse (pop) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUi-UD) and detrusor overactivty(Do) would co-exist in a number of patients. Management entails relieving the obstructive element. to determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUi-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure-absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure-assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. improvement of SUi UD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. ergo, vaginal pRS cures symptoms of MUi-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI. Mixed urinary incontinence (MUI) alone has been the leading cause of urinary incontinence in women above 65 years old. The ten-year cumulative incidence of urinary incontinence rates MUI as the first reported symptom in 37.2% of elderly patients 1. The International Urogynecological Association (IUGA) and International Continence Society (ICS) define MUI as the complaint of involuntary leakage of urine associated with exertion, sneezing, or coughing, as well as leakage associated with urgency 2. The cause of which is due to striated muscle atrophy, estrogen deficiency, abnormalities in histomorphology, and microstructural changes 3. Diagnosis of MUI through urodynamic studies pose a great challenge, since results fail to correlate with patient's symptoms, which lead to under diagnosis. Management of these group patients has generally been based on the predominant symptom that the patients report as the most bothersome 4. On the other hand, patients with pelvic organ prolapse (POP) often have lower urinary tract symptoms (LUTS). The use of urodynamic study for pre-operative evaluation of patients with POP becomes mandatory per recommendation by International Consultation on Incontinence 5. Urodynamic studies unmask occult stress urinary incontinence (SUI-UD) and identify women with concomitant detrusor overactivity (DO) and overt SUI-UD. Women with DO and SUI-UD are considered to have mixed type urinary incontinence (MUI-U). The incidence of MUI in patients with POP is 34.3% 6. Relieving the obstructive element becomes the main focus of management

Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery

“…Theoretically, artificial repair can improve or even cure pelvic floor dysfunction. In addition, relevant studies suggest that POP and SUI have similar etiology and pathogenesis, and the two often coexist [ 23 , 24 ]. Therefore, concurrent anti-SUI is the key to treating POP.…”

Polypropylene Anterior-apical single-incision mesh surgery in women with severe pelvic organ prolapse—a case series at 53 months median period follow-up

“…Only 2 patients had resolution of symptoms while 4 patients remained to be suffering from such, since restoration of the anatomical defect can only provide 56% objective cure. 25…”

Evaluation of the clinical effectiveness of modified sacrospinous ligament fixation via the anterior vaginal wall path for pelvic organ prolapse: A feasibility report based on 50 patients

“…These symptoms may be due to the urethra being obstructed preoperatively due to the severe prolapse of the organ, which has squeezed and distorted the urethra. Some patients also present with insidious stress incontinence, which gradually becomes apparent after pelvic floor reconstruction due to a change in the urethral angle ( 24 , 25 ). In this study, two new cases of lower urinary tract symptoms of varying degrees were found in the T4 group during the postoperative follow-up period, while no new symptoms were found in the mSSLF group.…”