69: Patient reported lower urinary tract symptoms following surgical treatment of apical pelvic organ prolapse

Abstract

To report on the prevalence of lower urinary tract symptoms (LUTS) in patients undergoing different forms of apical suspension with or without additional repairs and/or anti-incontinence procedures. After obtaining IRB approval, the database from a single hospital was searched for all patients undergoing apical prolapse repair with either a sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) between June 2011 and June 2016. During this 5 year period a total of 168 patients were identified. The electronic medical records (EMR) and operative records were reviewed. Patients included in the study were patients who underwent SSLF or USLS for apical prolapse with follow-up greater than 4 weeks with documentation of patient reported outcomes (PRO). Patients were excluded if they did not meet inclusion criteria or if there was no documentation of PRO. Data points included demographics, types of surgery, preoperative LUT complaints and postoperative PRO, with a focus on LUTS. Terminologies used were per guidelines by International Continence Society (ICS) and International Urogynecologic Association (IUGA). Data was evaluated utilizing descriptive and inferential statistical analyses and p < 0.05 was considered significant. One hundred sixty-eight patients were identified in the database; however, four were excluded because of incomplete data. Among these 164 patients, 211 individual symptoms were reported during last recorded follow-up visit. The majority of symptoms (69.2%) were LUTS and 30.8% were other symptoms including pelvic pain, dyspareunia, vaginal pain, discharge, vaginal bleeding and other lower genital tract symptoms. Overall 69 (42.1%) patients complained of at least one LUTS. Urinary urgency was the most commonly reported LUTS, reported by 25% of all patients. Urinary urgency incontinence (UUI) and frequency were reported by 15.2% and 13.4%, respectively. Other reported LUTS included nocturia (6.1%), stress urinary incontinence (SUI) (5.5%), voiding dysfunction including slow stream and straining (7.9%), incomplete bladder emptying or sensation of incomplete bladder emptying (3.0%), urinary tract infections (8.5%) and recurrent urinary tract infection (4.3%). Interestingly, significantly less patients complained of SUI at their last visit, 5.5% (9/164), compared to the first visit at around 4-6 weeks visit, 12.0% (19/158). Most patients are free of LUTS following apical suspension and additional pelvic organ prolapse reconstruction; however, 42.1% will have LUTS similar to symptoms prior to surgery or de novo following surgery. It is important to inform patients of the possibility of LUTS following surgery during surgical counseling.