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Urodynamic profile of voiding in patients with pelvic organ prolapse after surgery: a systematic review with meta-analysis

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Abstract

Introduction and hypothesis

Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP.

Methods

PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR).

Results

A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06–2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45–1.18). Patients who did not receive MUS presented a lower Qmax (IV = −3.19; 95%CI = −4.09 to −2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68–40.1) before surgery.

Conclusion

Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.

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Abbreviations

CI:

Confidence intervals

DO:

Detrusor overactivity

LUTS:

Lower urinary tract symptoms

MUS:

Mid-urethral sling

PdetQmax:

Detrusor pressure at maximum flow

PVR:

Post-void residual volume

Qmax:

Maximum flow

SUI:

Stress Urinary Incontinence

UUI:

Urgency urinary incontinence

VLPP:

Valsalva leak point pressure

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Author notes

  1. Danilo Budib Lourenço and Hugo Octaviano Duarte-Santos contributed equally to this work

Authors and Affiliations

  1. Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil

    Danilo Budib Lourenço, Hugo Octaviano Duarte-Santos, Alexandre Dib Partezani, Saulo Borborema Teles, Bianca Bianco, Luis Augusto Seabra Rios, Gustavo Caserta Lemos & Arie Carneiro

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  1. Danilo Budib Lourenço
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Contributions

H.O.D. Santos: project conceptualization and development, data extraction/analysis, data curation, visualization, manuscript writing/editing; D.B. Lourenço: project conceptualization and development, data extraction/analysis, data curation, visualization, manuscript writing/editing; A.D. Partezani: data extraction/analysis and manuscript editing; S.B. Teles: data extraction/analysis and manuscript editing; B. Bianco: resources, manuscript review and editing; L.A.S. Rios: visualization, manuscript review and editing; G.C. Lemos: resources, supervision, manuscript review, and editing; A. Carneiro: project conceptualization, supervision and administration, resources, manuscript writing/editing. All authors critically reviewed the manuscript and approved the final version of the manuscript.

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Correspondence to Arie Carneiro.

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Supplementary information

Supplementary Fig. 1

UDI-6 questionnaire scores before and after surgery for correction of pelvic organ prolapse with or without sling placement (PNG 156 kb)

High resolution image (TIFF 209 kb)

Supplementary Table 1

(DOCX 30 kb)

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Lourenço, D.B., Duarte-Santos, H.O., Partezani, A.D. et al. Urodynamic profile of voiding in patients with pelvic organ prolapse after surgery: a systematic review with meta-analysis. Int Urogynecol J 34, 53–65 (2023). https://doi.org/10.1007/s00192-022-05086-9

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