Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

A R Mothes,A R Mothes,A R Mothes,A Altendorf-Hofmann,I B Runnebaum,H K Mothes,H K Mothes,M P Radosa,M P Radosa,M P Radosa,A Kather,A Kather,J C Radosa

doi:10.1038/s41598-021-01565-z

Abstract

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann–Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67–8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03–1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85–2.38) and defect type (p = 0.02, B – 1.42, 95% CI – 2.65 to – 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.

Highlights

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior nativetissue repair
Additional to anatomical fascia defects, that are approached by reconstructive surgery, aging and connective tissue weakness are considered to be risk factors contributing to pelvic floor disorders[2]
Other questions that need to be addressed include whether the anatomic urethral length changes following female native-tissue prolapse repair, whether changes in urethral length differ by preoperative prolapse stage and/or anterior defect pattern, and what relative effects anatomic urethral length has on the urethral continence mechanism

Summary

Introduction

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior nativetissue repair. Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, with central defects. The maintenance or achievement of urinary continence after native-tissue prolapse repair is of clinical importance to avoid the need for continence procedures with the simultaneous use of alloplastic grafts in as many patients and for as long as possible. In the context of anatomical reconstruction, suburethral support using native tissue (as in Kelly plication) or alloplastic implants (as in sling procedures) might be as important as restoration of anatomy for the improvement of function. Other questions that need to be addressed include whether the anatomic urethral length changes following female native-tissue prolapse repair, whether changes in urethral length (postoperative vs preoperative) differ by preoperative prolapse stage and/or anterior defect pattern, and what relative effects anatomic urethral length has on the urethral continence mechanism

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