Effects of sacrocolposuspension on the lower urinary tract

Abstract

OBJECTIVE: Urinary incontinence and micturition disorders have been reported to be common in patients who have had sacrocolposuspension procedures for vaginal vault prolapse. From interviews with 213 patients who had this procedure in Birmingham from 1986 to 1992, it was found that 53% related complaints of some urine leakage and 44% related other complaints, including frequency, urgency, and voiding dysfunction. It is also well known that frequently urinary symptoms accompany severe defects in pelvic support. Our purpose was to determine whether sacrocolposuspension and cul-de-sac obliteration, with or without retropubic suspension and posterior colporrhaphy, had a causal relationship to lower urinary tract dysfunction or symptoms. STUDY DESIGN: Forty-five patients who had the procedures were felt to be evaluable on the basis of preoperative documentation of a history of lower urinary tract symptoms and an evaluation. Four to eighty months after surgery (mean 31 months, median 24 months) these patients were interviewed by use of a verbally administered questionnaire assessing symptoms, and 24 patients underwent urodynamic testing. Preoperative and postoperative data collected subjectively and objectively were analyzed with Fisher's exact test (two-tailed) or paired t test analysis. RESULTS: Lower urinary tract symptoms or dysfunction occurred in 87% of patients before and 49% of patients after sacrocolposuspension for vaginal vault prolapse in spite of correction of bladder support defects. Stress urinary incontinence was effectively treated in 92% of patients who underwent appropriate bladder neck suspension procedures. There was no evidence that subjective or objective voiding dysfunction, urinary frequency, urgency or urge incontinence, or subjective and objective stress incontinence increased after the above procedures. None of the seven patients who had no urinary symptoms preoperatively had new-onset lower urinary tract symptoms postoperatively that could be attributed to the surgery. CONCLUSIONS: (1) Lower urinary tract dysfunction is common in patients with significant pelvic relaxation. (2) Careful evaluation of the lower urinary tract is essential for treatment choice and to effectively counsel patients with total prolapse. (3) Sacrocolposuspension in itself does not significantly effect lower urinary tract function or symptoms.