The Effect of Posterior Wall Support Defects on Urodynamic Indices in Stress Urinary Incontinence
ABSTRACT To determine if posterior vaginal wall defects affect urodynamic indices and mask stress urinary incontinence.
Ninety women with grade 0, 1, 2, or 3 posterior wall defects were evaluated prospectively by complete urodynamics to assess their urinary complaints. None had severe anterior or apical support defects. Urethral pressure profilometry and cough stress test were performed with the posterior wall in the unretracted position and then with the posterior wall retracted using a split speculum. Analysis of covariance was used to compare adjusted mean differences in maximum urethral closure pressure, functional urethral length, and units of leakage volume during the cough stress test in the unretracted and retracted positions among the posterior wall grade groups.
In women with grade 3 posterior wall defects, there were significant changes from the unretracted to the retracted position in maximum urethral closure pressure of -7.0 cm H20, (99% confidence interval [CI] -12.4, -1.6), functional urethral length of -0.3 cm (99% CI -0.5, -0.1), and leak volume units of +0.7 (99% CI 0.4, 1.0) during the cough stress test. There were four women with grade 3 posterior wall defects who demonstrated potential stress incontinence when their posterior wall was retracted.
A grade 3 posterior wall defect may artificially raise maximum urethral closure pressure, increase functional urethral length, and mask urinary stress incontinence during a cough stress test. Women with grade 3 posterior wall defects should be tested with the posterior wall retracted during urodynamic evaluation.
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- "The MUCP has been reported to be increased by urethral mechanical closure due to the urethral kinking found in patients with pelvic organ prolapse.14-17 However, patients with stress urinary incontinence have been reported to show a decrease in the MUCP which leads to a decrease in functional urethral length.16,18,19 Subsequently, the incontinence symptoms are improved in pelvic organ prolapse patients because of increases in the MUCP and functional urethral length (owing to the prolapse). "
ABSTRACT: MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n = 13), 50s (n = 53), 60s (n = 54), and 70 and over (n = 16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n = 35), stage III (n = 76), and stage IV (n = 25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.Yonsei Medical Journal 07/2005; 46(3):408-13. DOI:10.3349/ymj.2005.46.3.408 · 1.26 Impact Factor
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ABSTRACT: Die posteriore Kolporrhaphie wurde im 19, Jahrhundert eingeführt. Ziel des Verfahrens war es, die Scheide und den Hiatus genitalis so zu verengen, dass die pelvinen Organe eine neue Auflage bekommen und somit erneut Halt im Becken finden. Bei der klassischen posterioren Kolporrhaphie zeigen sich Erfolgsraten von 76–96%. Alternativ zur klassischen posterioren Kolporrhaphie hat Richardson den spezifischen Defekt-Repair beschrieben. Hier finden sich Erfolgsraten von 56–100% (Cundiff u. Fenner 2004).
Article: Prolapse.[Show abstract] [Hide abstract]
ABSTRACT: There is currently no consensus on how much evaluation is required or needed when surgically managing women with pelvic organ prolapse. However, most would agree that optimal treatment is contingent upon a thorough assessment of historical and physical exam findings and an understanding of the relationshipbetween pelvic prolapse and coexisting functional derangements. This assessment very commonly requires ancillary testing in the hope of objectifying the cause of the associated functional derangements (Figure 4.1).Baillière s Clinical Obstetrics and Gynaecology 07/1988; 2(2):385-95. DOI:10.1007/978-1-84628-346-8_4