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  • Title: Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery.
    Author: Lo TS, Chua S, Uy-Patrimonio MC, Kao CC, Lin CH.
    Journal: Neurourol Urodyn; 2018 Sep; 37(7):2242-2248. PubMed ID: 29664135.
    Abstract:
    AIM: To determine the impact of vaginal pelvic reconstructive surgery (PRS) on detrusor underactivity (DU) patients having advanced pelvic organ prolapse (POP). METHODS: A retrospective study of patients who underwent PRS for advanced POP (POP-Q ≥ 3) with DU. Data regarding preoperative evaluation, surgical procedure, and post-operative management were collated. Patients were considered to have DU when detrusor pressure at maximum flow (Pdet Qmax ) was ≤10 cmH2 0 and peak flow rate (Qmax ) of ≤12 mL/s. Post-operative values more than the cut-off were considered objectively cured. Subjective cure was defined as having a negative response to UDI-6 Question 5, "Do you experience difficulty emptying your bladder?" RESULTS: A total of 49 patients were evaluated. Majority of the population were post-menopausal and multiparous. Preoperatively, 38 patients (75%) had stage III prolapse and 13 patients (26%) had stage IV. Subjective cure rate of DU was 76% (37/49) and objective cure rate was 47% (23/49). Post-operative DU (P < 0.001) significantly improved together with patients having normal urodynamic diagnosis (P < 0.001). Voiding function showed significant increase in Qmax (P < 0.001) and Pdet Qmax (P < 0.001) while PVR (P < 0.001) and cystometric capacity (P < 0.001) significantly decreased. These findings were observed in 89% (43/49) of patients with post-void residual urine (PVR) of <200 mL, 63% (31/49) with Qmax  > 12 mL/s, and 57% (28/49) with Pdet Qmax  >10 cmH2 0. CONCLUSION: Reversal of short-term or long-term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.
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