Correlation between stress urinary incontinence or urgency and anterior compartment defect before and after surgical treatment

Czech version

Authors: A. Martan ¹ ; K. Švabík ¹; J. Mašata ¹; R. El-Haddad ¹; M. Pavlikova ²
Authors‘ workplace: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc. ¹; EuroMISE Centrum, Ústav informatiky Akademie věd České republiky v. v. i., vedoucí centra prof. RNDr. J. Zvárová, DrSc. ²
Published in: Ceska Gynekol 2010; 75(2): 118-125

Overview

Objective:
We aimed to assess the occurrence of stress urinary incontinence (SUI) and urgency (U) before and after an operation to treat anterior compartment defect, and to ascertain whether there is a correlation between the position or mobility of the urethro-vesical junction (UVJ) and the lowest point of bladder base (N) and SUI and U before and after surgical treatment of the defect, using various procedures.

Design:
Prospective, randomized study.

Settings:
Department of Gynecology and Obstetrics, First Medical Faculty, Charles University and General Teaching Hospital, Prague.

Materials and methods:
87 women were enrolled who had proven symptomatic Pelvic Organ Prolapse POP ≥ II (Pelvic Organ Prolapse Quantitative – POP - Q) – specifically anterior compartment defect – cystocele; they were then randomized into three group according to the type of surgical procedure planned: the BM group, treated with the traditional Barnett-Macků technique of anterior vaginal plastic surgery (BM; n=18); the Gynemesh group, treated with anterior plastic surgery with free insertion of individualized mesh (Mesh; n=33); and the Prolift group, treated with an original kit with pre-set standard-size mesh which is anchored to the lower arm of pubis (Prolift; n=36). SUI tests were carried out for the women before the operation and 3-4 months afterwards, using International Consultation on Incontinence Questionnaire – Short form (ICIQ-UI SF) and objective assessment by cough-test, while we also took into account the urge symptom. Before and after the operation patients were also examined by 4D imaging (GE Voluson 730 Expert), with emphasis on the position of UVJ and N point at rest and at maximum Valsalva. Data were processed and analysed in open computer environment, R language, version 2.9.1.

Results:
The different groups of patients did not show statistically significant differences in demographic data. The results also show that there is no statistical difference between individual operation groups regarding occurrence of SUI: objectively this was established for 33% of patients, and according to ICIQ for 79%. Among women where SUI was not objectively proven, 74% felt SUI, while among women with objectively proved SUI, only one did not feel the urine leakage. This means that SUI is much more often subjectively felt than objectively proven. After the operation objective improvement of SUI occurred for 6% (5) patients, while it worsened for 16% (12) patients. The differences are not statistically significant. 78% (65 patients; n=83) felt incontinent before the operation compared with 66% (54 patients; n=82) after the operation, according to the ICIQ questionnaire. 18% (14) patients showed improvement and 5% (4) deterioration. In subjective assessment of the symptoms, improvement of SUI is more often recorded than worsening, to a statistically significant degree. 34% (30) patients in total suffered from urge before the operation (for three of them urge incontinence, for the others just urgency) and 8% (7) patients after the operation (of which one suffered from urge incontinence and 6 just urgency). This means that improvement occurred for 32% (25) and deterioration for just 3% (2) if patients. We have not ascertained any correlation between UVJ mobility, N point and urinary incontinence before and after the operation.

Conclusions:
The results of our study imply that the presence of SUI and U before an operation to treat anterior compartment defect is one of the main symptoms accompanying prolapse. While the operation may solve the SUI problem, it very often does not, as it deals mainly with eliminating the prolapse, or para-vaginal effect. We also failed to establish any correlation between mobility of the UVJ or N point and occurrence of SUI before and after the operation. We may, however, state that elevation of the N point – bladder base due to the operation results in mitigating U. Therefore, for reconstructive surgeries that do not treat SUI it is necessary that the operation is followed by a tape procedure in the second stage, ideally after the first operation has healed, i.e. 3 months at minimum.

Key words:
stress urinary incontinence, pelvic surgery, pelvic organ prolapse, transperineal ultrasound.

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