Abstract
Introduction and hypothesis
Pelvic organ prolapse (POP) reduction is often performed in the preoperative assessment of women before POP surgery. Using urethral pressure reflectometry (UPR), we sought to investigate how POP reduction affects the urethral closure mechanism.
Methods
Women with anterior or posterior vaginal wall prolapse stage ≥II with and without POP reduction were examined with a speculum. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest and during squeezing, and standardized stress tests with 300 ml saline. All examinations were repeated after insertion of a speculum.
Results
We included 38 women: 22 with anterior and 16 with posterior vaginal wall prolapse POP-Q stage ≥II. During POP reduction, resting and squeezing urethral pressures decreased by 2.5 cmH2O (p = 0.007) and 5.1 cmH2O (p < 0.0001), respectively, in all women. During POP reduction, the number of positive stress tests increased from four (18%) to eight (36%) in women with anterior vaginal wall prolapse and from one (6%) to nine (56%) in women with posterior vaginal wall prolapse.
Conclusions
POP reduction decreases urethral pressure, especially during squeezing, and consequently increases the number of positive stress tests. The test itself artificially deteriorates the urethral closure mechanism.
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Acknowledgments
We thank Nurse Berit Sejersen Larsen for her assistance with all examinations in this study.
Funding
The study was fully funded by the University of Copenhagen, as part of a PhD Scholarship. The University of Copenhagen had no part in the study.
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Y.K., G.L. and N.K. have received honoraria as investigators from Astellas. G.L. has also been a consultant for Contura.
Additional information
This paper was presented as an abstract at the International Continence Society’s 47th Annual Meeting in Florence, Italy, in September 2017.
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Khayyami, Y., Lose, G. & Klarskov, N. Prolapse reduction deteriorates the urethral closure mechanism. Int Urogynecol J 30, 489–493 (2019). https://doi.org/10.1007/s00192-018-3647-x
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DOI: https://doi.org/10.1007/s00192-018-3647-x