MP33-12 THE NATURAL HISTORY OF VOIDING EFFICIENCY FOLLOWING CORRECTION OF PARTIAL BLADDER OUTLET OBSTRUCTION IN WOMEN WITH PROLAPSE (2009-2015)

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-12 THE NATURAL HISTORY OF VOIDING EFFICIENCY FOLLOWING CORRECTION OF PARTIAL BLADDER OUTLET OBSTRUCTION IN WOMEN WITH PROLAPSE (2009-2015) Amy D. Dobberfuhl, Robyn K. Shaffer, Steven N. Goodman, and Bertha Chen Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author , Robyn K. ShafferRobyn K. Shaffer More articles by this author , Steven N. GoodmanSteven N. Goodman More articles by this author , and Bertha ChenBertha Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1083AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The diagnosis of partial bladder outlet obstruction (pBOO) in women with prolapse has largely relied on subjective complaints and long term urodynamic (UDS) predictors of outcomes in this population have been poorly characterized. We report our 6-year experience in women following prolapse repair. METHODS We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015 and reviewed the records of 266 women with preoperative UDS evaluation. Primary outcome was postoperative voiding efficiency (VE = voided volume ÷ capacity) and/or post void residual (PVR) after surgery. Data were analyzed in SAS using repeated measure mixed effects models to assess within and between group changes over time. RESULTS All 266 women (mean age 61 years) had preoperative UDS tracing, surgical and follow-up data available for analysis. There were 519 PVRs recorded at up to 2,949 days (mean 364, σ=639) and 9 time points (median 2, IQR 1-3) after surgery. Preoperative UDS revealed a mean: [email protected] 22 cmH2O (IQR 12-30), Qmax 18 mL/s (IQR 11-23), capacity 529 mL (IQR 370-659), PVR 120 mL (IQR 5-160). Women with prolapse [POP-Q Stage: I (n=14), II (n=120), III (n=118), IV (n=14)] underwent anterior-only (n=115), apical-only (n=41) or combination anterior-apical (n=110) prolapse repair. Using mixed effects models, significant UDS cutpoints associated with worsening postoperative PVR and/or VE over time were identified: BCI < 60 (11% reduction VE, p<0.05), capacity > 600 mL (59 mL higher PVR, p=0.01); preoperative PVR > 200 mL (93 mL higher PVR, p<0.01; 8% reduction VE, p<0.05). The Qmax < 10 mL/s cutpoint approached significance (7% reduction VE, p=0.053). Sling placement was associated with a 49 mL higher PVR (ref 99 mL, p<0.05) and non-significant 5% lower VE (ref 82%, p=0.058). High grade (Stage III or IV) prolapse was paradoxically associated with 6% higher VE (ref 78%, p<0.05). Urinary tract infections (n=120) were associated with a 77 mL higher PVR (ref 78 mL, p<0.01) and 13% reduction in VE (ref 86%, p<0.01). Factors not significantly predictive of worse PVR and/or VE include: all BOOI and [email protected] cutpoints, anterior versus apical repair, diabetes (n=37, p=0.92), hyperlipidemia (n=91, p=0.08), neuropathy (n=17, p=0.33), and obesity (n=44, p=0.76). CONCLUSIONS BOOI and [email protected] are poorly predictive of VE and/or PVR following prolapse surgery. Women with a BCI < 60, capacity > 600 mL or PVR > 200 mL are at risk of worsening VE and/or PVR following prolapse repair and should be considered for earlier pBOO intervention. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e433 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amy D. Dobberfuhl More articles by this author Robyn K. Shaffer More articles by this author Steven N. Goodman More articles by this author Bertha Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...