Changes in voiding function after laparoscopic sacrocolpopexy for advanced pelvic organ prolapse: a cohort study of 76 cases.

Abstract

We evaluated changes in voiding function at 3months after laparoscopic sacrocolpopexy (LSC) for advanced pelvic organ prolapse (POP) patients and identified risk predictors for postoperative voiding dysfunction. Seventy-six patients with advanced POP who underwent LSC were enrolled in this retrospective cohort study. Pre- and postoperative objective voiding function was assessed by uroflowmetry plus postvoid residual (PVR) volumes. Voiding dysfunction was defined as a maximum flow rate (Qmax)<15ml/s, average flow rate (Qave)<10ml/s, or PVR>50ml. Statistical analyses were performed using paired-sample t tests, McNemar's tests, and multivariate regression analyses. Thirty patients (39%) showed evidence of voiding dysfunction preoperatively, but two thirds of these patients were asymptomatic. Voiding dysfunction decreased significantly from baseline to 3months after surgery (39% vs. 21%, p=0.009), including a decrease among patients with Qave<10ml/s (32% vs. 17%, p=0.043) and PVR>50ml (24% vs. 9%, p=0.019). Voiding difficulty decreased significantly from baseline to 3months after surgery (32% vs. 9%, p<0.001); urgency and urinary incontinence symptoms did not exhibit significant improvement (p>0.05). Multivariate analysis identified Qave<10ml/s as the independent predictor of postoperative voiding dysfunction [p=0.014, odds ratio (OR)=4.77, 95% confidence interval (CI) 1.37-16.54]. Preoperative voiding dysfunction is common among patients with POP and significantly improves at 3months following LSC. A preoperative Qave<10ml/s was an independent risk factor for postoperative voiding dysfunction.