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Valdevenito JP, Mercado-Campero A, López-Fando L, Calvo CI, Manríquez V, Medina L. Dropped abdominal pressure at void in women. Int Urogynecol J 2022; 33:3275-3281. [PMID: 35445356 DOI: 10.1007/s00192-022-05202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS "Dropped pabd at void" occurs when pabd decreases below the previous resting pressure during voiding time. We sought clinical factors associated with this phenomenon and evaluated whether its correction modifies the urodynamic diagnosis. METHODS Retrospective cross-sectional study of non-neurological consecutive symptomatic women. The following definitions were used: "dropped pabd at void": decrease in pabd at Qmax ≥ 5 cmH2O; bladder outflow obstruction (BOO) (pdetQmax ≥ 25 cmH2O + Qmax ≤ 12 ml/s and female BOO index (pdetQmax - 2.2*Qmax) > 18; "low detrusor contraction strength": PIP1 (pdetQmax + Qmax) < 30. In patients with "dropped pabd at void", pdetQmax was corrected. RESULTS A total of 360 women were analyzed. Ninety-five percent of the women had a variation in pabd at Qmax between -13 and 53 cmH2O. "Dropped pabd at void" was found in 100 women (27.8%). History of stress urinary incontinence (SUI) surgery was significantly higher (p = 0.016) and symptoms of mixed urinary incontinence were significantly lower (p = 0.030) in patients with "dropped pabd at void". On multivariate analysis only the history of SUI surgery maintained its significance (OR = 1.787 [95% CI: 1.058, 3.017], p = 0.030). When correcting pdetQmax in women with "dropped pabd at void", 2 or 5 patients lost BOO diagnosis (depending on how it was diagnosed) and 7 patients gained a "low detrusor contraction strength" diagnosis. CONCLUSIONS Approximately one-quarter of women had "dropped pabd at void", which was associated with a history of SUI surgery. Correction of pdetQmax would lead to a 2.5% to 3.33% diagnostic modification.
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Affiliation(s)
- Juan Pablo Valdevenito
- Department of Urology, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, 8380456, Santiago, Chile. .,Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Alejandro Mercado-Campero
- Department of Urology, Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, 8380456, Santiago, Chile
| | - Luis López-Fando
- Department of Urology, Hospital Universitario de La Princesa, Madrid, España
| | - Carlos Ignacio Calvo
- Department of Urology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valentín Manríquez
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Loreto Medina
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
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Valdevenito JP, Mercado‐Campero A, Naser M, Castro D, Ledesma M, Arribillaga L. Voiding dynamics in women with urinary incontinence but without voiding symptoms. Neurourol Urodyn 2020; 39:2223-2229. [DOI: 10.1002/nau.24475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 07/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Juan P. Valdevenito
- Urodynamics Unit, Department of Urology Hospital Clínico Universidad de Chile Santiago Chile
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit Hospital Clínico Universidad de Chile Santiago Chile
| | | | - Michel Naser
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit Hospital Clínico Universidad de Chile Santiago Chile
| | - Daniela Castro
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit Hospital Clínico Universidad de Chile Santiago Chile
| | - Marta Ledesma
- Female Pelvic Floor Department Centro Urológico Profesor Bengió Córdoba Argentina
| | - Leandro Arribillaga
- Female Pelvic Floor Department Centro Urológico Profesor Bengió Córdoba Argentina
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. RECENT FINDINGS Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.
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Affiliation(s)
- Joshua A Cohn
- Department of Urology, Einstein Healthcare Network, 50 E. Township Line Road, Suite 202, Elkins Park, Philadelphia, PA, 19027, USA. .,Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Ariana L Smith
- University of Pennsylvania Health System and Perelman School of Medicine, Philadelphia, PA, USA
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Feasibility and benefits of the ewe as a model for vaginal surgery training. Int Urogynecol J 2017; 28:1573-1577. [DOI: 10.1007/s00192-017-3313-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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Mueller ER, Litman H, Rickey LR, Sirls L, Norton P, Wilson T, Moalli P, Albo M, Zimmern P. Comparison of flowrates and voided volumes during non-instrumented uroflowmetry and pressure-flow studies in women with stress incontinence. Neurourol Urodyn 2014; 34:549-53. [PMID: 24797058 DOI: 10.1002/nau.22625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Abstract
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 (VV) 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 VV 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 700 ml. CONCLUSION The difference between PFS Qmax and NIF Qmax increases as VV 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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Affiliation(s)
- Elizabeth R Mueller
- Department of Urology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.,Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Heather Litman
- New England Research Institutes, Watertown, Massachusetts
| | - Leslie R Rickey
- Department of Urology, University of Maryland, Baltimore, Maryland
| | - Larry Sirls
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
| | - Peggy Norton
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Tracey Wilson
- Department of Urology, University of Alabama Medical Center, Birmingham, Alabama
| | - Pamela Moalli
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Albo
- Department of Urology, University of California, San Diego, California
| | - Philippe Zimmern
- Department of Urology, Southwestern Medical Center, Dallas, Texas
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Couri BM, Lenis AT, Borazjani A, Paraiso MFR, Damaser MS. Animal models of female pelvic organ prolapse: lessons learned. ACTA ACUST UNITED AC 2014; 7:249-260. [PMID: 22707980 DOI: 10.1586/eog.12.24] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pelvic organ prolapse is a vaginal protrusion of female pelvic organs. It has high prevalence worldwide and represents a great burden to the economy. The pathophysiology of pelvic organ prolapse is multifactorial and includes genetic predisposition, aberrant connective tissue, obesity, advancing age, vaginal delivery and other risk factors. Owing to the long course prior to patients becoming symptomatic and ethical questions surrounding human studies, animal models are necessary and useful. These models can mimic different human characteristics - histological, anatomical or hormonal, but none present all of the characteristics at the same time. Major animal models include knockout mice, rats, sheep, rabbits and nonhuman primates. In this article we discuss different animal models and their utility for investigating the natural progression of pelvic organ prolapse pathophysiology and novel treatment approaches.
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Affiliation(s)
- Bruna M Couri
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue ND20 Cleveland, OH 44195, USA
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Repeatability of post-void residual urine ≥ 100 ml in urogynaecologic patients. Int Urogynecol J 2011; 23:207-9. [DOI: 10.1007/s00192-011-1614-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022]
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Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms. Int J Gynaecol Obstet 2010; 111:119-21. [DOI: 10.1016/j.ijgo.2010.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 05/28/2010] [Accepted: 07/07/2010] [Indexed: 11/24/2022]
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de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, Kirby MG, Koelbl H, Espuna-Pons M, Milsom I, Tubaro A, Wagg A, Vierhout ME. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn 2010; 29:30-9. [PMID: 20025017 DOI: 10.1002/nau.20858] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS In this review we try to shed light on the following questions: *How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? *Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? *What is the possible pathophysiology of OAB in POP? *Do OAB symptoms and DO change after conservative or surgical treatment of POP? METHODS We searched on Medline and Embase for relevant studies. We only included studies in which actual data about OAB symptoms were available. All data for prolapse surgery were without the results of concomitant stress urinary incontinence (SUI) surgery. RESULTS Community- and hospital-based studies showed that the prevalence of OAB symptoms was greater in patients with POP than without POP. No evidence was found for a relationship between the compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP (surgery, pessaries) resulted in an improvement in OAB symptoms. It is unclear what predicts whether OAB symptoms disappear or not. When there is concomitant DO and POP, following POP surgery DO disappear in a proportion of the patients. Bladder outlet obstruction is likely to be the most important mechanism by which POP induces OAB symptoms and DO signs. However, several other mechanisms might also play a role. CONCLUSIONS There are strong indications that there is a causal relationship between OAB and POP.
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Affiliation(s)
- T A de Boer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Mueller E, Wei J, Nygaard I, Brubaker L, Varner E, Visco A, Cundiff GW, Weber AM, Ghetti C, Kreder K. The correlation of voiding variables between non-instrumented uroflowmetery and pressure-flow studies in women with pelvic organ prolapse. Neurourol Urodyn 2008; 27:515-21. [PMID: 18551567 DOI: 10.1002/nau.20568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To (1) correlate peak and maximum flow rates from non-instrumented flow (NIF) and pressure-flow studies (PFS) in women with pelvic organ prolapse (POP); (2) measure the impact of voided volume and degree of prolapse on correlations. METHODS We compared four groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the colpopexy and urinary reduction efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI). Group 3 (n = 74) and Group 4 participants (n = 73), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms. Group 3 planned sacrocolpopexy. Group 4 planned a different treatment option. Participants completed standardized uroflowmetry and pressure voiding studies. RESULTS Subjects' median age was 61 years; median parity 3% and 80% had stage III or IV POP. Based on the Blaivas-Groutz nomogram, 49% of all women were obstructed. NIF and PFS peak and average flow rates had low correlations with one another (0.31, P < 0.001 and 0.35, P < 0.001, respectively). When NIF and PFS voided volumes were within 25% of each other, the peak and average flow rate correlations improved (0.52, P < 0.001 and 0.57, P < 0.001, respectively). As vaginal prolapse increased, correlations between NIF and PFS peak and average flow rates decreased. CONCLUSION 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.
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Affiliation(s)
- Elizabeth Mueller
- Department of Urology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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