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Lo TS, Harun F, Alzabedi A, Chiung HK, Jhang LS, Hsieh WC. Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors. J Minim Invasive Gynecol 2024; 31:102-109. [PMID: 37952873 DOI: 10.1016/j.jmig.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE To determine the outcome of voiding function 1 year after pelvic reconstructive surgery (PRS) in women with bladder outlet obstruction (BOO). DESIGN Retrospective cohort study. SETTING Tertiary referral hospital. PATIENTS A total of 1894 women underwent PRS for advanced pelvic organ prolapse (POP) stages 3 to 4 with urodynamic findings of BOO. INTERVENTIONS PRS. MEASUREMENTS The primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic testing at 1 year postoperatively. The secondary outcomes were to identify the different risk factors for persistence voiding dysfunction (VD) 1 year after PRS. MAIN RESULTS A total of 431 women with Pelvic Organ Prolapse Quantification stages 3 and 4, urodynamic study of maximum urinary flow rate ≤15 mL/s, and detrusor pressure at maximum flow ≥20 cm H2O were included. Resumption of normal voiding function was found in 91% (n = 392 of 431), whereas 9% (n = 39 of 431) remained to have VD 1 year postoperatively. Those with persistent VD, 20.5% (n = 8 of 39) remained having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression revealed factors associated with postoperative VD were pre-operative maximal cystometric capacity ≥500 mL and postvoid residual volume ≥200 mL. CONCLUSION VD may persist in women with BOO after PRS, particularly in those with preoperative maximal cystometric capacity of >500 mL and postvoid residual volume >200 mL.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan (Dr. Lo); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan (Dr. Lo); Chang Gung University, School of Medicine, Taoyuan, Taiwan (Dr. Lo).
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah) Kuala Lumpur, Malaysia, (Dr. Harun)
| | - Aisha Alzabedi
- Women Health Center, International Medical Center Hospital, Jeddah, Saudi Arabia (Dr. Alzabedi)
| | - Huan-Ka Chiung
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Lan-Sin Jhang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
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Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Arteaga SM, Nambiar AK, Riogh ANA, O'Connor E, Omar MI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van Poelgeest-Pomfret ML, van den Bos TWL, van der Vaart H, Harding CK. European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia. Eur Urol 2022; 82:60-70. [PMID: 35181193 DOI: 10.1016/j.eururo.2022.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. OBJECTIVE To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. EVIDENCE ACQUISITION The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to the treatment of underactive bladder, obstruction of the bladder outlet, and nighttime urination.
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Affiliation(s)
- Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marie Carmela Lapitan
- College of Medicine, Philippine General Hospital, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | | | - Benoit Peyronnet
- European Association of Urology, Arnhem, The Netherlands; Department of Urology, University of Rennes, Rennes, France
| | - Veronique Phé
- Department of Urology, AP-HP, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | | | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Christopher K Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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