Posterior colporrhaphy does not affect the urethral closure mechanism

TY - JOUR

T1 - Posterior colporrhaphy does not affect the urethral closure mechanism

AU - Khayyami, Yasmine

AU - Lose, Gunnar

AU - Klarskov, Niels

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction and hypothesis: Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. Methods: This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher’s exact test, where appropriate; p values OpenSPiltSPi0.05 were considered statistically significant. Results: Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p = 0.4), during squeezing (p = 0.2) or straining (p = 0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. Conclusions: The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.

AB - Introduction and hypothesis: Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. Methods: This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher’s exact test, where appropriate; p values OpenSPiltSPi0.05 were considered statistically significant. Results: Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p = 0.4), during squeezing (p = 0.2) or straining (p = 0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. Conclusions: The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.

KW - Adult

KW - Aged

KW - Female

KW - Humans

KW - Middle Aged

KW - Postoperative Period

KW - Preoperative Period

KW - Pressure

KW - Prospective Studies

KW - Urethra/physiopathology

KW - Urinary Bladder/physiopathology

KW - Urinary Incontinence, Stress/etiology

KW - Uterine Prolapse/classification

U2 - 10.1007/s00192-017-3401-9

DO - 10.1007/s00192-017-3401-9

M3 - Journal article

C2 - 28695343

SN - 0937-3462

VL - 29

SP - 125

EP - 130

JO - International Urogynecology Journal

JF - International Urogynecology Journal

IS - 1

ER -