Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery
• Female lower urinary tract anatomy

Background:

• Pelvic organ prolapse (POP) affects many women, often involving anatomical changes.
• Urethral length is a critical factor in female lower urinary tract function.
• Native-tissue repair aims to restore pelvic anatomy without synthetic materials.

Purpose of the Study:

• To evaluate changes in urethral length following anterior native-tissue prolapse repair.
• To identify factors influencing pre- and postoperative urethral length.
• To assess the relationship between urethral length and surgical outcomes, including the need for tension-free vaginal tape (TVT) surgery.

Main Methods:

• Retrospective analysis of 394 patients undergoing anterior native-tissue prolapse repair.
• Statistical analysis including Mann-Whitney, Wilcoxon tests, linear, and logistic regression.
• Evaluation of age, prolapse stage, defect pattern, urodynamic findings, and TVT indication.

Main Results:

• Median urethral length increased from 14 mm preoperatively to 22 mm postoperatively (p < 0.01).
• Longer preoperative urethral length was associated with lateral defects and increased stress incontinence risk.
• Postoperative urethral length was influenced by prolapse stage and defect type.

Conclusions:

• Anterior native-tissue prolapse repair, including Kelly plication, effectively increases urethral length, suggesting re-urethralization.
• The procedure shows particular benefit for central defects.
• Further research is needed to explore the functional implications of urethral length changes in aging connective tissue.