Effective parameters of urodynamic study before pelvic organ prolapse surgery and validation of concomitant surgery on urinary outcomes: Retrospective cohort study.

Abstract

OBJECTIVE: To evaluate effective parameters of preoperative urodynamic study (UDS) before performing surgery for pelvic organ prolapse (POP) and to validate effectiveness of concomitant surgery on urinary outcomes. METHODS: This was a retrospective cohort study of 308 patients who had UDS before POP surgery from January 2006 through December 2010 at Yonsei University Severance Hospital, Seoul, Korea. The patients who were diagnosed with stress urinary incontinence (SUI) by positive result of UDS (group 1) had a concomitant sling operation with POP surgery. And the patients were not diagnosed with SUI by negative result of UDS (group 2) did not. RESULTS: The prevalence rate of de novo SUI in group 2 (3.1%, n = 4) higher than group 1 (1.7%, n = 3), but there was no statistically significant difference between the two groups. We checked 5 parameters of UDS (valsalva leak point pressure, maximal urethral closing pressure [MUCP], maximal flow rates, detrusor pressure at maximal flow [PdetMax], maximal cystometric capacity confidence). PdetMax and MUCP was statistically significant parameter in postoperative de novo SUI (odds ratio [OR], 1.020; 95% confidence intervals [CI], 1.001-1.038) and postoperative de novo urgency urinary incontinence (UUI; OR 0.969; 95% CI, 0.942-0.996). CONCLUSION: This study suggests that results of preoperative UDS and concomitant surgery can be associated with prevalence rate of postoperative de novo SUI. Focused on prevalence of postoperative urinary complications, concomitant surgery was better than only prolapse surgery. PdetMax in SUI and MUCP in UUI were statistically significant parameters of UDS related on urinary outcome.