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Why do women have voiding dysfunction and de novo detrusor instability after colposuspension?
L Bombier1, R M Freeman, E P Perkins
1Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, Derriford Hospital, Plymouth, UK.
Objective:
To investigate the causes of voiding dysfunction and new detrusor instability after colposuspension.
Design:
Prospective, observational study.
Setting:
Urogynaecology unit, district general hospital.
Population:
Seventy-seven women undergoing colposuspension for genuine stress incontinence.
Methods:
The following factors were investigated: 1. bladder neck elevation by magnetic resonance imaging before and after surgery; 2. urethral compression by measuring bladder neck approximation to the pubis with magnetic resonance imaging after surgery (anterior compression) and the distance between the medial stitches during surgery (lateral compression); 3. clinical and urodynamic factors.
Main Outcome Measures:
1. Post-operative voiding function (i.e. first day of voiding and day of catheter removal); 2. objective evidence of detrusor instability three months post-operatively.
Results:
Pre-operative peak flow rate (P = 0.004), straining during voiding (P = 0.005), increasing age (P < 0.001), operative elevation (P < 0.001) and anterior urethral compression (P = 0.001) were associated with the number of days of post-operative catheterisation. Increasing age (P = 0.02), previous bladder neck surgery (P = 0.04), operative elevation (P = 0.049) and anterior urethral compression (P < 0.001) were associated with detrusor instability at three months.
Conclusion:
Surgical factors (bladder neck elevation and compression) are associated with voiding dysfunction and detrusor instability after colposuspension. These findings have implications for prevention.