Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery.

Abstract

To determine the impact of vaginal pelvic reconstructive surgery (PRS) on detrusor underactivity (DU) patients having advanced pelvic organ prolapse (POP). A retrospective study of patients who underwent PRS for advanced POP (POP-Q ≥ 3) with DU. Data regarding preoperative evaluation, surgical procedure, and post-operative management were collated. Patients were considered to have DU when detrusor pressure at maximum flow (Pdet Qmax ) was ≤10 cmH2 0 and peak flow rate (Qmax ) of ≤12 mL/s. Post-operative values more than the cut-off were considered objectively cured. Subjective cure was defined as having a negative response to UDI-6 Question 5, "Do you experience difficulty emptying your bladder?" A total of 49 patients were evaluated. Majority of the population were post-menopausal and multiparous. Preoperatively, 38 patients (75%) had stage III prolapse and 13 patients (26%) had stage IV. Subjective cure rate of DU was 76% (37/49) and objective cure rate was 47% (23/49). Post-operative DU (P < 0.001) significantly improved together with patients having normal urodynamic diagnosis (P < 0.001). Voiding function showed significant increase in Qmax (P < 0.001) and Pdet Qmax (P < 0.001) while PVR (P < 0.001) and cystometric capacity (P < 0.001) significantly decreased. These findings were observed in 89% (43/49) of patients with post-void residual urine (PVR) of <200 mL, 63% (31/49) with Qmax > 12 mL/s, and 57% (28/49) with Pdet Qmax >10 cmH2 0. Reversal of short-term or long-term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.