The Effect of Posterior Wall Support Defects on Urodynamic Indices in Stress Urinary Incontinence

Brown University, Providence, Rhode Island, United States
Obstetrics and Gynecology (Impact Factor: 4.37). 05/1998; 91(5 Pt 1):710-4. DOI: 10.1016/S0029-7844(98)00049-0
Source: PubMed

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four women with grade 3 posterior wall defects who demonstrated potential stress incontinence when their posterior wall was retracted.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.

  • [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    ABSTRACT: Urethral pressure profilometry is commonly used as a diagnostic test for stress urinary incontinence. The objective of this article is to review the published literature on urethral pressure profilometry to summarize its usefulness. MEDLINE was used to search the published English literature from 1966 to October 2000 for full-length original research articles on urethral pressure profilometry and stress urinary incontinence in women. Terms related to urethral pressure profilometry are defined consistently but techniques are not standardized, introducing variation in test results. Reproducibility of urethral pressure profilometry parameters is poor, both because of biological variation and variation within the test procedure itself (related in part to lack of standardization). Parameters of urethral pressure profilometry do not distinguish between continent and incontinent women and do not characterize the severity of incontinence or urethral incompetence. It is, therefore, concluded that urethral pressure profilometry is not a useful diagnostic test for stress urinary incontinence in women. Its use in clinical management is not supported by current evidence.
    Obstetrical and Gynecological Survey 12/2001; 56(11):720-35. DOI:10.1097/00006254-200111000-00024 · 2.36 Impact Factor
Show more