The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine

The aim of the study was to investigate the association between severity of anterior vaginal or apical prolapse and postvoid residual volume (PVR).

The charts of all women who presented to Urogynecology Clinic at Olive View-UCLA Medical Center for a 2-year period were reviewed. Demographic data, the degree of prolapse pelvic organ prolapse quantification points Aa, Ba, and C, and PVR were recorded. Patients with incomplete pelvic organ prolapse quantification assessment or improperly measured PVR were excluded.

Three hundred fifty-two patients were included. Median age was 54 years (range, 26-80). Mean gravidity and parity were 4.4 and 3.7, respectively. Mean body mass index was 29.9 kg/m. One hundred forty-nine women had previous pelvic surgery. Median PVR was 25 mL, and 40 patients (11.4%) had a PVR of 100 mL or greater.Considering 15 potential PVR predictors, we found that the position of apex/cervix (point C) significantly correlated with an increase in PVR and also after controlling for the other significant covariates (rate of change b = 4.7% increase in PVR/cm, P = 0.0007). The other significant (P < 0.05) covariates were gravidity (5.7% per pregnancy), postmenopausal status (32.4%), and vaginal surgical history (61.4%). This was not true, however, for the anterior vaginal position (points Aa, Ba; P > 0.15). There was no difference in mean PVR in patients with versus without a hysterectomy (P = 0.236).

Elevated PVR values have long been linked with prolapse of the anterior vaginal wall. We found that there is a linear association between PVR and the anatomic position of the apex. There was no association of PVR with the position of the anterior vaginal wall.