Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse

被引:4
作者
Padoa, Anna [1 ,2 ]
Levy, Eyal [3 ,4 ]
Fligelman, Tal [1 ,2 ]
Tomashev-Dinkovich, Roni [1 ,2 ]
Tsviban, Anna [1 ,2 ]
Serati, Maurizio [5 ]
机构
[1] Shamir Assaf Harofe Med Ctr, Dept Obstet & Gynecol, Zerifin, Israel
[2] Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
[3] Bnai Zion Med Ctr, Dept Obstet & Gynecol, Haifa, Israel
[4] Technion Israel Inst Technol, Ruth & Bruce Rappaport Fac Med, Haifa, Israel
[5] Univ Insubria, Dept Obstet & Gynecol, Varese, Italy
关键词
Body mass index; Detrusor overactivity; Overactive bladder; Pelvic organ prolapse; Pelvic organ prolapse surgery; Urinary urgency; URINARY-INCONTINENCE; OUTLET OBSTRUCTION; RISK-FACTORS; SYMPTOMS; PREVALENCE; TERMINOLOGY; SEVERITY; OBESITY; WEIGHT; REPAIR;
D O I
10.1007/s00192-022-05313-3
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction and hypothesis Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB). Methods In this retrospective analysis, women with POP stage 3-4 and OAB who underwent POP repair during November 2012-December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated. Results One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m(2) vs 25.7 kg/m(2), p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m(2) (OR 1.8 [95% CI: 1.1-7.2]; p = 0.04) as predictive factor for persistent urgency. Conclusions In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.
引用
收藏
页码:759 / 767
页数:9
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