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Predictors for detrusor overactivity following extensive vaginal pelvic reconstructive surgery
Tsia-Shu Lo1,2,3,4, Shailaja Nagashu5,6, Wu-Chiao Hsieh2
1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, People's Republic of China.
Aim:
This study aims to identify the predictors for detrusor overactivity (DO) in women following extensive vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP).
Methods:
We enrolled 1503 women who had prolapse POP-Q stage ≥ 3 and underwent vaginal PRS with or without MUS from January 2006 to December 2015. All subjects completed a 72-h voiding diary, IIQ-7, UDI-6, POPDI-6, and PISQ-12. Urodynamics (UDS) was performed pre- and post-operatively.
Results:
Among 1503 women, 56 patients were excluded due to incomplete data. Women who had trans-vaginal mesh were 1083 of 1447 (74.8%) and concomitant MUS were 353 (24.4%). Pre-operative DO were 245 (16.9%) and 24.5% (60/245) of them continued to have persistent DO post-operatively. Women who had normal pre-operative stable detrusor were 1202 (83.1%) and 3.5% (30/1202) developed de novo DO post-operatively. The overall incidence of post-operative DO was 6.2% (90/1447). Patients with age ≥66 year, neurological factors like Cerebrovascular accident and Parkinsonian disease, pre-operative bladder outlet obstruction (BOO) maximum urethral closure pressure (MUCP) ≥60 cmH2 O, Maximum flow rate (MFR) <15 mL/s and detrusor at maximum flow (Dmax) ≥20 cmH2 O) and post-void residue (PVR) ≥200 mL hold a significant higher risk of developing DO either persistent or de novo following PRS.
Conclusion:
Age ≥66 year, neurological factors like CVA and Parkinsonian disease, pre-operative MUCP ≥60 cmH2 O, MFR < 15 mL, Dmax ≥ 20 cmH2 O, and PVR ≥ 200 mL are independent risk factors for developing post-operative DO following vaginal PRS for advanced POP.