Hypothesis / aims of study
Lower urinary tract symptoms (LUTS) may change after pelvic organ prolapse (POP) surgery. Thus, the aim of this study was to elucidate (1) the changes of LUTS and (2) the changes in values of urodynamic parameters between baseline and after POP surgery.
Study design, materials and methods
Between November 2011 and December 2015, medical records of all consecutive women who underwent anterior transvaginal mesh surgery (ATVM) but without concomitant mid-urethral sling surgery were reviewed. The bladder outlet obstruction was defined when the detrusor pressure at maximum flow rate was not less than 40 cmH2O, and the maximum flow rate was less than 12 mL/s [1].
STATA software was used for statistical analysis. Wilcoxon signed-rank test or McNemar’s test was used for statistical analysis as appropriate. P < 0.05 was considered as statistically significant.
Results
Medical records of 160 women were reviewed in this study. After surgery, the incidence of overactive bladder syndrome (OAB) was increased after ATVM surgery (18% at baseline vs. 28% after surgery, p=0.03). Nonetheless, the incidences of stress urinary incontinence (SUI, 99% at baseline vs. 43% after surgery, p<0.0001) and urodynamic stress incontinence (83% at baseline vs. 51% after surgery, p<0.0001) were decreased after ATVM surgery (Table 1).
Comparisons of urodynamic parameters between baseline and after surgery are shown in Table 2. A decrease in pad weight (20.5±2.7g at baseline vs. 9.4±2.0 g after surgery, p<0.0001), postvoid residual volume, maximum urethral procedure, maximum urethral closure pressure and functional profile length were noted after ATVM surgery. However, an increase in the volumes of first desire, normal desire and strong desire was noted after ATVM surgery (Table 2).
Seven (4.4%) women had a recurrence of POP due to cervical elongation. In addition, five (3.1%) women had mesh extrusion and needed mesh revision.
Interpretation of results
ATVM surgery could improve the severity of SUI, despite of a decrease of urethral closure function. In addition, the findings of a decrease of postvoid residual volume and an increase in the volume of first desire, normal desire and strong desire hint that ATVM surgery might be benefit for women with OAB (Table 2); however, OAB was significantly increased after ATVM surgery (18% at baseline vs. 28% after surgery, p=0.03, Table 1). Thus, we could not exaggerate the therapeutic effect of ATVM surgery on pre-existent OAB.