Severe genital prolapse and its relationship to detrusor instability

Abstract

Twelve women with severe genital prolapse through the vaginal introitus were evaluated urodynamically with and without a properly fitted vaginal ring pessary in order to evaluate the relationship between severe genital prolapse and detrusor instability in women. Provocative retrograde medium-fill urethrocystometry confirmed detrusor instability in all patients. Seven women showed resolution of uninhibited detrusor contractions during provocative maneuvers after pessary placement. Nine women underwent vaginal hysterectomy and vaginal repair operation; a bladder neck suspension was performed if indicated. Five women returned postoperatively for urodynamic evaluation. Three of 4 women who responded to pessary placement with resolution of uninhibited detrusor contractions had a stable bladder and no uregency symptoms postoperatively. One patient who did not respond to pessary placement continued to have symptomatic motor urge incontinence after a vaginal repair procedure. The data suggest that genital prolapse may provoke uninhibited bladder contraction by increasing urethral resistance, and that vaginal pessary placement may be useful in predicting which patient with genital prolapse and uninhibited detrusor contractions during cystometry will have a stable bladder after vaginal repair operation.