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Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse (POP) Quantification System
Published on: September 20, 2018
The effect of genital prolapse on voiding
L J Romanzi1, D C Chaikin, J G Blaivas
1Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York, USA.
The Journal of Urology
|January 23, 1999
Summary
Genital prolapse can cause bladder outlet obstruction, often relieved by a vaginal pessary. Voiding difficulty and urethral hypermobility are common, with pessary use aiding diagnosis in severe cases.
Area of Science:
- Urogynecology
- Pelvic Floor Disorders
- Urodynamics
Background:
- Genital prolapse is a common condition affecting women, often associated with lower urinary tract symptoms.
- The relationship between prolapse severity and specific urodynamic findings like bladder outlet obstruction and voiding difficulty requires further elucidation.
Purpose of the Study:
- To investigate the association between genital prolapse severity and lower urinary tract symptoms.
- To determine if a vaginal pessary can relieve bladder outlet obstruction in women with prolapse.
- To assess the correlation of voiding difficulty, urethral hypermobility, bladder outlet obstruction, occult stress incontinence, detrusor instability, and impaired detrusor contractility with prolapse.
Main Methods:
- Prospective evaluation of 60 women with genital prolapse using pressure-flow video urodynamics and cotton swab testing.
- Assessment of leak point pressure and uroflowmetry before and after vaginal pessary insertion in patients with severe prolapse.
- Categorization of patients based on cystocele grade (1-2 vs. 3-4).
Main Results:
- Urethral hypermobility and voiding difficulty were more prevalent in women with severe prolapse (grade 3-4).
- Bladder outlet obstruction was significantly higher in severe prolapse (58%) compared to mild prolapse (4%), and a vaginal pessary resolved it in 94% of severe cases.
- Detrusor instability correlated with prolapse severity, while impaired detrusor contractility and intrinsic sphincter deficiency did not.
Conclusions:
- Lower urinary tract symptoms, including voiding difficulty and bladder outlet obstruction, are frequently associated with genital prolapse.
- A vaginal pessary is a useful tool in urodynamic assessment for identifying symptomatic and occult conditions in women with severe prolapse.
- While detrusor instability and urethral hypermobility correlate with prolapse degree, impaired contractility and intrinsic sphincter deficiency do not show such a correlation.
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