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The urethral closure mechanism is deteriorated after anterior colporrhaphy

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Abstract

Introduction and hypothesis

Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy.

Methods

A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300 ml saline, and answering the International Consultation on Incontinence – Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score > 1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values <0.05 were considered statistically significant.

Results

Twenty-eight women who underwent anterior colporrhaphy completed the study. PO-Abd 50 decreased 12 cmH2O after surgery (p < 0.0001). Five women developed postoperative SUI and one had persistent SUI; the six women’s preoperative PO-Abd 50 was lower than the rest (p < 0.01). If preoperative PO-Abd 50 was ≤65 cmH2O, the positive predictive value for postoperative SUI was 50%, and if PO-Abd 50 was ≥85 cmH2O, the negative predictive value was 100%.

Conclusions

The urethral closure mechanism deteriorates after anterior colporrhaphy. Using UPR, we can calculate a woman’s risk of SUI after anterior colporrhaphy.

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Acknowledgements

We thank Nurse Berit Sejersen Larsen for her assistance with all examinations in this study.

Funding

The study was funded as a PhD scholarship by the University of Copenhagen. The University of Copenhagen was not involved in the study.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Herlev Gentofte University Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark

    Yasmine Khayyami, Gunnar Lose & Niels Klarskov

Authors
  1. Yasmine Khayyami
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  2. Gunnar Lose
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  3. Niels Klarskov
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Corresponding author

Correspondence to Yasmine Khayyami.

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Conflicts of Interest

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 Annual Meeting of International Continence Society in Tokyo, Japan, September 13th–16th, 2016, and as an abstract at the Nordic Urogynecological Association’s 30th Bi-Annual Meeting in Reykjavik, Iceland, April 27th–29th, 2017.

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Khayyami, Y., Lose, G. & Klarskov, N. The urethral closure mechanism is deteriorated after anterior colporrhaphy. Int Urogynecol J 29, 1311–1316 (2018). https://doi.org/10.1007/s00192-017-3504-3

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  • DOI: https://doi.org/10.1007/s00192-017-3504-3

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