Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors

Abstract

Study ObjectiveTo determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO). DesignRetrospective cohort study SettingTertiary Referral Hospital PatientsOne thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO InterventionsPelvic Reconstructive Surgery MeasurementsThe primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS. Main ResultsTotal of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml. ConclusionVoiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.