Hypothesis / aims of study
Pelvic organ prolapse and lower urinary tract symptoms often co-exist. However, the relationship between different compartments of prolapse and urinary symptoms is not well understood. Furthermore, there is even less published data exploring how each prolapse compartment effects the female bladder. Multiple studies have shown an association between grade of prolapse and overactive bladder (OAB) [1]. Anterior compartment prolapse in particular, has been previously shown to be related to severity of OAB symptoms [2]. Conversely there have been studies showing no relationship between urgency incontinence and prolapse grade [3].
The relationship between prolapse compartment, prolapse grade, and the urodynamic finding of detrusor overactivity is even less well investigated in the literature. In this study we aim to investigate how each prolapse compartment: anterior, mid or apical, and posterior, is associated with urodynamic findings of detrusor overactivity or urodynamic stress incontinence.
Does clinical examination of prolapse predict urodynamic findings?
Study design, materials and methods
We examined the urodynamic traces, clinical symptoms, and clinical examinations of women with pelvic organ prolapse and lower urinary tract symptoms referred to a tertiary level urogynaecology unit. Saline urodynamics were performed following ICS urodynamics recommendations, and all women had urodynamics performed with a vaginal pessary in situ. None of the women included in the study had undergone hysterectomy or previous pelvic floor surgery.
Statistical analysis was performed using IBM SPSS Statistics 29. Chi-squared and linear regression models were used to explore the relationship between compartment of prolapse, stage of prolapse, and urodynamic findings.
Interpretation of results
We found there was no statistically significant relationship between the presence of significant prolapse in particular compartments, and the presence of detrusor overactivity or urodynamic stress incontinence during normal saline urodynamics. We did find that grade of posterior compartment prolapse did have a statistically significant relationship with the presence of detrusor overactivity but with a small effect (R2=0.071)
There were no significant correlations between prolapse compartment and maximum detrusor pressures seen on urodynamics. Where the maximum detrusor pressure was used as a measure of severity of detrusor overactivity.