Voiding dynamics of pelvic organ prolapse: Large scale comparative study

Abstract

Purpose: To determine the voiding dynamics of the patients with pelvic organ prolapse (POP).

Materials and methods: A retrospective patient file review was performed of 877 female patients with lower urinary tract symptoms. After exclusion criteria 373 female patients were eligible for the study. Two patient groups w/wo prolapse were identified. The symptoms, patient characteristics, patterns of free urine flow, and detrusor voiding pressure curves were compared between two groups. A comparison of the urodynamic findings between the subgroups (mild/moderate, severe, and w/o prolapse) was made and shown on a scatter plot graphics of P_det Q_max versus Q_max as well.

Results: A total of 373 patients with median age 54 (18-92), 189 (51%) had varying degrees and forms of POP while 184 (49%) did not have any prolapse (p < 0.003). Logistic regression analysis results showed that older age [p = 0.023, odds ratio (OR) = 1.01, confidence interval (CI): (1.00-1.03)], weaker pelvic floor muscle strength [p = 0.032, OR = 1.67, CI: (1.04-2.69)], more frequent symptom of hesitancy [p = 0.003 OR = 2.15 CI: (1.29-3.58)], prolonged-tailed shaped curve pattern of free urine flow [p = 0.027 OR = 1.97 CI: (1.08-3.58)], and higher P_det Q_max (22 cmH₂ O) values [p = 0.002, OR = 1.02, CI: (1.00-1.03)] were the independent different features of the patients with prolapse. Subgroup urodynamic analysis showed significantly lower free flowmetry Q_max and higher P_det Q_max values in patients with severe prolapse. Prolonged/tailed-shaped curve pattern of free urine flow was significantly more frequent in patients with prolapse.

Conclusions: Voiding dynamics of the patients with prolapse were significantly different from the patients' w/o prolapse. They had higher P_det Q_max values, more frequent symptom of hesitancy, and prolonged shaped free flow curve pattern. Free flow Q_max values were lower in patients with severe prolapse.

Keywords: bladder outlet obstruction; female; incontinence; pelvic organ prolapse; urodynamics; voiding difficulties.