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Frigerio M, Barba M, Cola A, Spelzini F, Milani R, Manodoro S. Coexisting overactive-underactive bladder and detrusor overactivity-underactivity in pelvic organ prolapse. Int J Gynaecol Obstet 2023; 160:256-262. [PMID: 35617299 PMCID: PMC10083922 DOI: 10.1002/ijgo.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The coexisting overactive-underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity-underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery. METHODS This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non-COUB according to baseline symptoms and into DOU and non-DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery. RESULTS A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034). CONCLUSION POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB.
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Affiliation(s)
- Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Marta Barba
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Alice Cola
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynecology, AUSL Romagna, Ospedale Infermi, Rimini, Italy
| | - Rodolfo Milani
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
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Kitta T, Abe H, Ting-Wen H, Fujikawa M, Nakazono M, Sasa T, Doi Y, Toki S, Okada D, Ochi A, Suzuki K, Kitagawa Y, Shinohara N. Novel insight into the correlation between hernia orifice of cystocele and lower urinary tract function: a pilot study. BMC Womens Health 2022; 22:164. [PMID: 35562822 PMCID: PMC9102938 DOI: 10.1186/s12905-022-01747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Although the VD mechanism due to cystocele is not fully understood, different vaginal compartments have rarely been closely examined. This study attempted to further elucidate the correlation between POP and VD through a new subgroup classification using cystoscopy. METHODS This study reviewed clinical records of 49 women who underwent cystocele repair. All patients were scheduled for laparoscopic sacrocolpopexy, preoperatively underwent uroflowmetry and postvoid residual urine volume (PVR) measurement, and completed pelvic floor function questionnaires. Bladder examination by cystoscopy was additionally performed using the lithotomy position with the Valsalva maneuver. RESULTS Subjects were divided into four groups according to hernia orifice presence determined by cystoscopy, which included the trigone type, posterior wall type, trigone and urethra type, and trigone and posterior wall type. The posterior wall type had statistically higher PVR values versus the trigone and posterior wall type (P = 0.013). The posterior wall type had statistically lower values for average urine flow rate versus the urethra and trigone type (P = 0.020). There were no significant differences noted in the pelvic floor function questionnaires among the four groups. CONCLUSIONS A new bladder defect classification based upon hernia orifice location was associated with lower urinary tract function. Posterior wall hernia presence caused significant voiding function deterioration. This new subgroup classification, which can more clearly identify and indicate bladder function, is also comparable among patients.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7; Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Huang Ting-Wen
- Department of Urology, Ushikuaiwa General Hospital, Ushiku, Japan
| | | | - Minoru Nakazono
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Taiki Sasa
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Yukiko Doi
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Sari Toki
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Daigo Okada
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Atsuhiko Ochi
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Koichiro Suzuki
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | | | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7; Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Predictors of Clinical Outcome in Women with Pelvic Organ Prolapse Who Underwent Transvaginal Mesh Reconstruction Surgery. Medicina (B Aires) 2022; 58:medicina58020148. [PMID: 35208472 PMCID: PMC8880025 DOI: 10.3390/medicina58020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/09/2022] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: To identify the predictors of clinical outcomes in women with pelvic organ prolapse (POP) who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation. Materials and Methods: All women with POP who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation, were reviewed. Results: Between January 2011 and May 2019, a total of 206 consecutive women were reviewed, including 68 women receiving POP reconstruction with transobturator mesh fixation and 138 women who underwent POP reconstruction with sacrospinous mesh fixation. The least experienced surgeon (hazard ratio = 804.6) and advanced stage of cystocele (hazard ratio = 8.80) were the predictors of POP recurrence, especially those women with stage 4 of cystocele. Young age (hazard ratio = 0.94) was a predictor for mesh extrusion, especially those women with age ≤67 years. Follow-up interval (odds ratio = 1.03, p = 0.02) was also an independent predictor of mesh extrusion. High maximum flow rate (Qmax, hazard ratio = 1.03) was the sole predictor of postoperative stress urinary incontinence, especially those women with Qmax ≥19.2 mL/s. Preoperative overactive bladder syndrome (hazard ratio = 3.22) were a predictor for postoperative overactive bladder syndrome. In addition, overactive bladder syndrome rate improved after surgery in the sacrospinous group (p = 0.0001). Voiding dysfunction rates improved after surgery in both sacrospinous and transobturator groups. Conclusions: Predictors of clinical outcome in women who underwent transvaginal POP mesh reconstruction are identified. The findings can serve as a guide for preoperative consultation of similar procedures.
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Prevalence of detrusor underactivity and bladder outlet obstruction in women with cystocele and changes in voiding function after cystocele repair. J Formos Med Assoc 2020; 119:1764-1771. [DOI: 10.1016/j.jfma.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 01/26/2023] Open
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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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Jaunarena JH, Kowalik CG, Delpe SD, Kaufman MR, Dmochowski RR, Stuart Reynolds W. Effects of Pelvic Organ Prolapse on the Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Detrusor underactivity in pelvic organ prolapse. Int Urogynecol J 2017; 29:1111-1116. [DOI: 10.1007/s00192-017-3532-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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Kira S, Mitsui T, Kobayashi H, Haneda Y, Sawada N, Takeda M. Detrusor pressures in urodynamic studies during voiding in women. Int Urogynecol J 2016; 28:783-787. [DOI: 10.1007/s00192-016-3203-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
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Rademakers K, Apostolidis A, Constantinou C, Fry C, Kirschner-Hermanns R, Oelke M, Parsons B, Nelson P, Valentini F, Gammie A. Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014. Neurourol Urodyn 2016; 35:307-11. [PMID: 26872573 DOI: 10.1002/nau.22776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/04/2015] [Indexed: 12/20/2022]
Abstract
AIMS At present, existing bladder outlet obstruction (BOO) nomograms for women are still not universally accepted. Moreover, only limited information is available regarding bladder contractility in women. The aim is to present the discussions and recommendations from the think tank session "Can we construct and validate contractility and obstruction nomograms for women?" held at the 2014 International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK. METHODS An overview of clinical significance, bladder mechanics and modelling, lack of existing nomograms for women, and development of new nomograms were presented and discussed in a multidisciplinary think tank session. This think tank session was based on a collaboration between physicians, engineers, and researchers and consensus was achieved on future research initiatives. RESULTS AND CONCLUSIONS Based on the think tank discussion, the ICI-RS panel put forward the following recommendations: the need to acquire normative age-matched data in women to define "normal" and "pathological" values of urodynamic parameters; the inclusion of additional clinical data in new nomograms and the use of this extra dimension to develop clinically applicable nomograms for female BOO and contractility; and finally, the need to take into account the variability of BOO in women when developing female bladder contractility nomograms.
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Affiliation(s)
- Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | - Christopher Fry
- School of Physiology and Pharmacology, University of Bristol, United Kingdom
| | - Ruth Kirschner-Hermanns
- University Clinic, Clinic of Urology/Neuro-Urology Bonn, Rheinisch Friedrich-Wilhelms University, Germany
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Brian Parsons
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Pierre Nelson
- ER6-Université Pierre et Marie Curie (Paris 06), Paris, France
| | | | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
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Chae JY, Park GY, Kim JH, Kim HJ, Bae JH, Lee JG, Moon DG, Oh MM. Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele. Eur J Obstet Gynecol Reprod Biol 2014; 174:146-9. [DOI: 10.1016/j.ejogrb.2013.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/30/2013] [Accepted: 12/08/2013] [Indexed: 11/28/2022]
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Current world literature. Curr Opin Urol 2012; 22:336-45. [PMID: 22677776 DOI: 10.1097/mou.0b013e3283551cbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sekido N. Bladder contractility and urethral resistance relation: what does a pressure flow study tell us? Int J Urol 2012; 19:216-28. [PMID: 22233177 DOI: 10.1111/j.1442-2042.2011.02947.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hydrodynamic analysis of a pressure flow study is the only reliable method to determine the presence or absence of a bladder outlet obstruction, especially benign prostatic obstruction. To interpret the results of pressure flow study in benign prostatic obstruction, understanding the outlines of the basic theory about evaluation of the relationship between bladder contractility and urethral resistance relation is of paramount importance. In contrast, hydrodynamic analysis of pressure flow study in conditions other than benign prostatic obstruction is complicated by the limits of theories about the hydrodynamics of the lower urinary tract. In this review, the proposed hydrodynamic theories about the relationship between bladder contractility and urethral resistance relation are outlined. Then, problems encountered in the application of hydrodynamic analysis of pressure flow study to diseases other than benign prostatic obstruction are discussed.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
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