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International Urogynecology Journal

Erschienen in:

27.01.2021 | Original Article

Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation

verfasst von: Maren Himmler, Martin Kohl, Aidana Rakhimbayeva, Magdalena Witczak, Alexander Yassouridis, Bernhard Liedl

Erschienen in: International Urogynecology Journal | Ausgabe 10/2021

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Abstract

Introduction and hypothesis

The objective was to investigate the prevalence for voiding dysfunction and if symptom improvement can be achieved by adequate pelvic floor surgery.

Methods

We evaluated the Propel Study data from 281 women with pelvic organ prolapse (POP) stage 2–4. Bother caused by obstructive micturition, voiding dysfunction, and coexisting pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI) preoperatively and 6, 12, and 24 months after vaginal prolapse repair. Successful reconstruction (Pelvic Organ Prolapse Quantification [POP-Q] stage 0–I throughout the 2-year follow-up at all compartments, “responders”), was compared with all others (“non-responders”).

Results

Prevalence of voiding dysfunction was significantly reduced after surgery for all patients with “moderate” to “quite a bit” of bother (“R2”) regarding all examined PFDI questions. Defects of the posterior/apical compartment and lower stage defects were found to cause obstructive micturition, which improved significantly after POP surgery. Six months after surgery, the prevalence of R2 for voiding dysfunction symptoms was reduced significantly for responders compared with non-responders. Significant reduction of R2 in patients with rectoceles could be shown for some PFDI questions, whereas the rate was lower in patients with cystoceles. Other pelvic floor symptoms often coexisted in patients with voiding dysfunction symptoms and improved significantly after surgery as well.

Conclusions

Symptoms of voiding dysfunction are frequent in female patients with POP and can significantly improve after vaginal mesh-augmented prolapse repair even for posterior and minor defects. Before counseling patients to undergo POP surgery because of their obstructive symptoms, other causes of voiding dysfunction must first have been ruled out.

Bradley CS, Kennedy CM, Nygaard IE. Pelvic floor symptoms and lifestyle factors in older women. J Womens Health (Larchmt). 2005;14(2):128–36. https://doi.org/10.1089/jwh.2005.14.128.CrossRef

Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol. 1999;161(2):581–6.CrossRef

Zacharin RF. The suspensory mechanism of the female urethra. J Anat. 1963;97:423–7.PubMedPubMedCentral

Cole EE, Kaufman MR, Scarpero HM, Dmochowski RR. The effects of isolated posterior compartment defects on lower urinary tract symptoms and urodynamic findings. BJU Int. 2006;97(5):1024–6. https://doi.org/10.1111/j.1464-410X.2006.06130.x.CrossRefPubMed

Petros PE, Ulmsten U. Role of the pelvic floor in bladder neck opening and closure I: muscle forces. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(2):74–80. https://doi.org/10.1007/bf02764822.CrossRefPubMed

Gordon AM, Huxley AF, Julian FJ. The variation in isometric tension with sarcomere length in vertebrate muscle fibres. J Physiol. 1966;184(1):170–92. https://doi.org/10.1113/jphysiol.1966.sp007909.CrossRefPubMedPubMedCentral

Papa Petros PE, Ulmsten U. Role of the pelvic floor in bladder neck opening and closure II: vagina. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(2):69–73. https://doi.org/10.1007/bf02764821.CrossRefPubMed

Liedl B, Inoue H, Sekiguchi Y, Gold D, Wagenlehner F, Haverfield M, et al. Update of the integral theory and system for management of pelvic floor dysfunction in females. Eur Urol Suppl. 2018;17:100–8.CrossRef

Corona-Quintanilla DL, Castelan F, Fajardo V, Manzo J, Martinez-Gomez M. Temporal coordination of pelvic and perineal striated muscle activity during micturition in female rabbits. J Urol. 2009;181(3):1452–8. https://doi.org/10.1016/j.juro.2008.10.103.CrossRefPubMed

10.

Clinicaltrials https://clinicaltrials.gov/ct2/show/study/NCT00638235?cond=NCT00638235&rank=1.

11.

Himmler M, Rakhimbayeva A, Sutherland SE, Roovers JP, Yassouridis A, Liedl B (2020) The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms. Int Urogynecol J https://doi.org/10.1007/s00192-00020-04440-z.CrossRefPubMedPubMedCentral

12.

Lukban JC, Roovers JP, Vandrie DM, Erickson T, Zylstra S, Patel MP, et al. Single-incision apical and posterior mesh repair: 1-year prospective outcomes. Int Urogynecol J. 2012;23(10):1413–9. https://doi.org/10.1007/s00192-012-1692-4.CrossRefPubMed

13.

Uren AD, Drake MJ. Definition and symptoms of underactive bladder. Investig Clin Urol. 2017;58(Suppl 2):S61–7. https://doi.org/10.4111/icu.2017.58.S2.S61.CrossRefPubMedPubMedCentral

14.

Chapple CR, Osman NI, Birder L, van Koeveringe GA, Oelke M, Nitti VW, et al. The underactive bladder: a new clinical concept? Eur Urol. 2015;68(3):351–3. https://doi.org/10.1016/j.eururo.2015.02.030.CrossRefPubMed

15.

Goeschen K. Posterior fornix syndrome: comparison of original (2004) and modified (2015) post-PIVS anatomic and symptomatic results: a personal journey. Pelviperineology 2015;34(3):85–91.

16.

Liedl B, Goeschen K, Yassouridis A, Inoue H, Abendstein B, Muller-Funogea IA, et al. Cure of underactive and overactive bladder symptoms in women by 1,671 apical sling operations gives fresh insights into pathogenesis and need for definition change. Urol Int. 2019;103(2):228–34. https://doi.org/10.1159/000500329.CrossRefPubMed

17.

Marinkovic SP, Stanton SL. Incontinence and voiding difficulties associated with prolapse. J Urol. 2004;171(3):1021–8. https://doi.org/10.1097/01.ju.0000111782.37383.e2.CrossRefPubMed

18.

Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80. https://doi.org/10.1002/nau.20144.CrossRefPubMed

19.

Bush MB, Liedl B, Wagenlehner F, Petros P. A finite element model validates an external mechanism for opening the urethral tube prior to micturition in the female. World J Urol. 2015;33(8):1151–7. https://doi.org/10.1007/s00345-014-1419-x.CrossRefPubMed

20.

Petros P, Richardson PA. TFS posterior sling improves overactive bladder, pelvic pain and abnormal emptying, even with minor prolapse. A prospective urodynamic study. Pelviperineology. 2010;29:52–5.

21.

Petros P, Lynch W, Bush M. Surgical repair of uterosacral/cardinal ligaments in the older female using the tissue fixation system improves symptoms of obstructed micturition and residual urine. Pelviperineology. 2015;34:1–5.

22.

Liedl B, Goeschen K, Durner L. Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction. Curr Opin Urol. 2017;27(3):274–81. https://doi.org/10.1097/MOU.0000000000000395.CrossRefPubMed

23.

Stanford EJ, Moore RD, Roovers JP, Courtieu C, Lukban JC, Bataller E, et al. Elevate anterior/apical: 12-month data showing safety and efficacy in surgical treatment of pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2013;19(2):79–83. https://doi.org/10.1097/SPV.0b013e318278cc29.CrossRefPubMed

Titel: Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation
verfasst von: Maren Himmler
Martin Kohl
Aidana Rakhimbayeva
Magdalena Witczak
Alexander Yassouridis
Bernhard Liedl
Publikationsdatum: 27.01.2021
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 10/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04649-y

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Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation