Urgency resolution following prolapse surgery: is voiding important?

Abstract

The objective of this study was to assess whether resolution of urgency symptoms in women undergoing surgical repair of pelvic organ prolapse (POP) is associated with any measurable change in voiding parameters. This was a prospective observational study. Women with symptomatic POP stage 2 or greater requiring surgery and who had concurrent urinary urgency and/or urinary urgency incontinence (UUI) were eligible for inclusion. Uroflowmetry data was collected from eligible women with urgency who underwent POP repair both preoperatively and at 10 weeks postoperative. Previously published preliminary data were used for an a priori power calculation. Urgency was assessed pre- and postoperatively with the Urgency Perception Scale (UPS). Participants were divided into those who experienced urgency resolution and those with persistent urgency. Differences in voiding parameters were evaluated at baseline and postoperatively in the two groups. The primary outcome measures were change in maximum flow rate and presence of urgency symptoms as determined by the UPS 10 weeks postoperatively. A paired Student's t test was used to evaluate whether there was any significant difference in uroflowmetry parameters between the two groups postoperatively, with an unpaired Student's t test test being used to evaluate any differences in these parameters at baseline. Discrete data were evaluated using Fisher's exact test. One hundred and twenty-eight women were recruited to the study. Urgency resolved in 61.7 % of participants, with resolution being associated with a significant increase in maximum flow rate from 11.2 [confidence interval (CI) 3.4-20.1] to 26.9 (CI 17.1-35.2) (p = 0.03), even when corrected for voiding volume. This large prospective study indicates that urgency resolution after prolapse repair is associated with an increase in urinary flow rate, indicating a possible aetiological role for voiding in women with POP and urgency.