Pelvic organ prolapse may be linked to obstructive voiding pattern in women with detrusor overactivity

Researchers have found an obstructive voiding pattern in women with urge incontinence and detrusor overactivity who also have pelvic organ prolapse.

Potential for Surgical Correction

The finding underscores “the potential for surgical correction to alleviate some urinary symptoms,” write Reut Rotem (Cork University Maternity Hospital, Ireland) and colleagues in the Archives of Gynecology and Obstetrics.

Study Design and Participant Demographics

The retrospective analysis involved 303 women who underwent urodynamic studies between 2018 and 2021 at the university-affiliated tertiary medical center. Of these, 152 (50.2%) had urodynamic evidence of detrusor overactivity, with 11.8% also having a pelvic organ prolapse.

Higher Rates of Previous Pelvic Surgery

The 18 women with a pelvic organ prolapse were more likely than the 134 women without to have a numerically higher rate of previous pelvic surgery (38.9 vs 21.3%), and to have undergone a vaginal hysterectomy (38.9 vs 16.4%) or anterior repair (11.1 vs 1.5%).

Urodynamic Parameters and Voiding Patterns

The researchers found that most urodynamic parameters were similar between the two groups. One exception was hesitancy, which was 13 seconds in women with prolapse compared with 8 seconds in women without prolapse, a significant difference.

Reduced Peak Flow Rate and Increased Flow Time

There was also a non-significant trend for a reduced median peak flow rate (Q max), which was 12 mL/second in women with prolapse versus 18 mL/second in those without, and an increased flow time of 55 seconds versus 40 seconds.

Possible Mechanical Obstruction Due to Prolapse

“[T]he diminished Q max coupled with the increase in flow time and hesitancy in the [pelvic organ prolapse] cohort, could hint at a mechanical obstruction of urine flow due to prolapse,” suggest Rotem et al.

Shared Mechanism Between Prolapse and OAB

This finding, combined with previous study results suggesting heightened nerve growth factor levels in women with overactive bladder (OAB) and uterine prolapse, “hints at a probable shared mechanism wherein the prolapse influences OAB’s onset,” they add.

Implications for Pelvic Floor Repairs

The researchers note that previous research has indicated that pelvic floor repairs may improve OAB symptoms, which is in agreement with their hypothesis.

Future Research and Clinical Implications

They conclude: “[O]ur findings provide a robust foundation for future investigations and hint at potential changes in urogynecological decision-making. Such insights might lead to the development of enhanced diagnostic methods and therapeutic interventions.”

Read the article here: Arch Gynecol Obstet 2024; doi:10.1007/s00404-024-07414-4

To access to the complete publication, please contact medical_information@pierre-fabre.com 

Obstructive Voiding Patterns in Women with Urge Incontinence and Pelvic Organ Prolapse

A recent study has identified obstructive voiding patterns in women with urge incontinence and detrusor overactivity who also have pelvic organ prolapse, highlighting the potential for surgical intervention to alleviate urinary symptoms.

Study Overview:

• Participants: 303 women who underwent urodynamic studies between 2018 and 2021 at a university-affiliated tertiary medical center.
• Key Findings: 152 women (50.2%) had urodynamic evidence of detrusor overactivity, and 11.8% of these also had pelvic organ prolapse.

Surgical History:

• Women with pelvic organ prolapse had higher rates of previous pelvic surgery (38.9% vs 21.3%).
• They were also more likely to have undergone vaginal hysterectomy (38.9% vs 16.4%) or anterior repair (11.1% vs 1.5%).

Urodynamic Parameters:

• Hesitancy: Women with prolapse experienced longer hesitancy (13 seconds) compared to those without prolapse (8 seconds).
• Peak Flow Rate: There was a non-significant trend towards a reduced median peak flow rate (12 mL/second in women with prolapse vs 18 mL/second in those without).
• Flow Time: Increased flow time was observed in women with prolapse (55 seconds vs 40 seconds).

Mechanisms and Implications:

• The findings suggest a possible mechanical obstruction of urine flow due to prolapse, indicated by the diminished peak flow rate and increased hesitancy and flow time.
• Previous studies showing elevated nerve growth factor levels in women with OAB and uterine prolapse support the hypothesis of a shared mechanism influencing OAB onset.

Clinical Recommendations:

• The study suggests that pelvic floor repairs may improve OAB symptoms.
• Findings provide a foundation for future research and potential changes in urogynecological decision-making, aiming for enhanced diagnostic methods and therapeutic interventions.

Conclusion:

• The study emphasizes the importance of considering pelvic organ prolapse in the management of urinary symptoms and the potential benefits of surgical correction in these cases.

Read the article here: World J Urol 2024; 42: 139

To access to the complete publication, please contact medical_information@pierre-fabre.com