Advertisement

Concomitant Functional Disorders in Genito-Urinary Prolapse

  • Enrico Finazzi Agrò
  • Daniele Bianchi
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)

Abstract

Genito-urinary prolapse can present with functional disorders, with potentially adverse impacts on the patient’s quality of life and social activities. These functional disorders can either be concomitant with the genito-urinary prolapse or may occur secondary to the prolapse. They can include urinary, sexual and faecal symptoms and pelvic pain or discomfort, as well as urinary tract infections. Nevertheless, some conditions could be unmasked by prolapse correction techniques, indicating the need for a careful evaluation prior to any treatment. Overactive bladder syndrome (OAB) has a particularly high prevalence, and its treatment consists of behavioural changes, weight reduction, drug therapy or physical therapies that include percutaneous posterior tibial nerve stimulation (PTNS) and sacral nerve modulation (SNS). Treatment of pelvic organ prolapse in association with urinary incontinence may include pelvic organ suspension and a (simultaneous or subsequent) midurethral sling.

References

  1. 1.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN, Association, International Urogynecological and Society, International Continence. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.  https://doi.org/10.1002/nau.20798.
  2. 2.
    Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, Chapple CR, Kaplan S, Tubaro A, Aiyer LP, Wein AJ. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60.  https://doi.org/10.1111/j.1464-410X.2009.08427.x. Epub 2009 Mar 5.CrossRefPubMedGoogle Scholar
  3. 3.
    Lim JR, Bak CW, Lee JB. Comparison of anxiety between patients with mixed incontinence and those with stress urinary incontinence. Scand J Urol Nephrol. 2007;41(5):403–6. Epub 2007 Apr 13.CrossRefGoogle Scholar
  4. 4.
    de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, Kirby MG, Koelbl H, Espuna-Pons M, Milsom I, Tubaro A, Wagg A, Vierhout ME. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn. 2010;29(1):30–9.  https://doi.org/10.1002/nau.20858.CrossRefPubMedGoogle Scholar
  5. 5.
    Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Res Rep Urol. 2016;8:113–22.  https://doi.org/10.2147/RRU.S93636.eCollection.2016.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017. pii: S0002–9378(17)30174–6.  https://doi.org/10.1016/j.ajog.2017.01.039. [Epub ahead of print].
  7. 7.
    Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol. 2004;3(1):46–53.CrossRefGoogle Scholar
  8. 8.
    Thiagamoorthy G, Kotes S, Zacchè M, Cardozo L. The efficacy and tolerability of mirabegron, a β3 adrenoceptor agonist, in patients with symptoms of overactive bladder. Ther Adv Urol. 2016;8(1):38–46.  https://doi.org/10.1177/1756287215614237.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Olivera CK, Meriwether K, El-Nashar S, et al. Nonantimuscarinic treatment for overactive bladder: a systematic review. Am J Obstet Gynecol. 2016;215(1):34–57.  https://doi.org/10.1016/j.ajog.2016.01.156. Epub 2016 Feb 4.CrossRefPubMedGoogle Scholar
  10. 10.
    Wagg A, Nitti VW, Kelleher C, Castro-Diaz D, Siddiqui E, Berner T. Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a potential alternative to antimuscarinics. Curr Med Res Opin. 2016;32(4):621–38.  https://doi.org/10.1185/03007995.2016.1149806. Epub 2016 Feb 17.CrossRefPubMedGoogle Scholar
  11. 11.
    Voorham JC, De Wachter S, Van den Bos TW, Putter H, Lycklama À, Nijeholt GA, Voorham-van der Zalm PJ. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: a randomized controlled trial. Neurourol Urodyn. 2016.  https://doi.org/10.1002/nau.23180. [Epub ahead of print].
  12. 12.
    Di Gangi Herms AM, Veit R, Reisenauer C, Herms A, Grodd W, Enck P, Stenzl A, Birbaumer N. Functional imaging of stress urinary incontinence. NeuroImage. 2006;29(1):267–75. Epub 2005 Sep 8.CrossRefGoogle Scholar
  13. 13.
    Lamin E, Parrillo LM, Newman DK, Smith AL. Pelvic floor muscle training: underutilization in the USA. Curr Urol Rep. 2016;17(2):10.  https://doi.org/10.1007/s11934-015-0572-0.CrossRefPubMedGoogle Scholar
  14. 14.
    Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1–7.  https://doi.org/10.1016/j.ajog.2010.02.037. Epub 2010 May 1.
  15. 15.
    Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189(6):2194–201.  https://doi.org/10.1016/j.juro.2012.11.175. Epub 2012 Dec 3.CrossRefPubMedGoogle Scholar
  16. 16.
    Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agrò E. Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol. 2013;13:61.  https://doi.org/10.1186/1471-2490-13-61.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn. 2012;31(8):1206–16.  https://doi.org/10.1002/nau.22251. Epub 2012 May 11.CrossRefPubMedGoogle Scholar
  18. 18.
    Vandoninck V, van Balken MR, Finazzi Agrò E, Petta F, Micali F, Heesakkers JP, Debruyne FM, Kiemeney LA, Bemelmans BL. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32.CrossRefGoogle Scholar
  19. 19.
    Gupta P, Ehlert MJ, Sirls LT, Peters KM. Percutaneous tibial nerve stimulation and sacral neuromodulation: an update. Curr Urol Rep. 2015;16(2):4.  https://doi.org/10.1007/s11934-014-0479-1.CrossRefPubMedGoogle Scholar
  20. 20.
    Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, Yan X, Haag-Molkenteller C, EMBARK Study Group. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol. 2017;197(2S):S216–23.  https://doi.org/10.1016/j.juro.2016.10.109. Epub 2016 Dec 22.
  21. 21.
    Robinson D, Cardozo L, Milsom I, Pons ME, Kirby M, Koelbl H, Vierhout M. Oestrogens and overactive bladder. Neurourol Urodyn. 2014;33(7):1086–91.  https://doi.org/10.1002/nau.22464. Epub 2013 Jul 19.CrossRefPubMedGoogle Scholar
  22. 22.
    Salvatore S, Serati M, Ghezzi F, Uccella S, Cromi A, Bolis P. Efficacy of tolterodine in women with detrusor overactivity and anterior vaginal wall prolapse: is it the same? BJOG. 2007;114(11):1436–8. Epub 2007 Sep 17.CrossRefGoogle Scholar
  23. 23.
    Nguyen JK, Bhatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166(6):2263–6.CrossRefGoogle Scholar
  24. 24.
    de Boer TA, Kluivers KB, Withagen MI, Milani AL, Vierhout ME. Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery. Int Urogynecol J. 2010;21(9):1143–9.  https://doi.org/10.1007/s00192-010-1152-y. Epub 2010 Apr 24.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, Amundsen CL, Schaffer J, Meikle SF, Spino C, Pelvic Floor Disorders Network. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67.  https://doi.org/10.1056/NEJMoa1111967.CrossRefGoogle Scholar
  26. 26.
    Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, Zyczynski H, Brown MB, Weber AM, Pelvic Floor Disorders Network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66.CrossRefGoogle Scholar
  27. 27.
    Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, Koelbl H, van Kerrebroeck P, Wein AJ. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014;65(2):389–98.  https://doi.org/10.1016/j.eururo.2013.10.015. Epub 2013 Oct 26.CrossRefPubMedGoogle Scholar
  28. 28.
    Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38.  https://doi.org/10.2147/IJWH.S55383. eCollection 2014.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Fletcher SG, Haverkorn RM, Yan J, Lee JJ, Zimmern PE, Lemack GE. Demographic and urodynamic factors associated with persistent OAB after anterior compartment prolapse repair. Neurourol Urodyn. 2010;29(8):1414–8.  https://doi.org/10.1002/nau.20881.CrossRefPubMedGoogle Scholar
  30. 30.
    Serati M, Topazio L, Bogani G, Costantini E, Pietropaolo A, Palleschi G, Carbone A, Soligo M, Del Popolo G, Li Marzi V, Salvatore S, Finnazzi AE. Urodynamics useless before surgery for female stress urinary incontinence: are you sure? Results from a multicenter single nation database. Neurourol Urodyn. 2016;35(7):809–12.  https://doi.org/10.1002/nau.22804. Epub 2015 Jun 9.CrossRefPubMedGoogle Scholar
  31. 31.
    Huang L, He L, Wu SL, Sun RY, Lu D. Impact of preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse on clinical management in Chinese women. J Obstet Gynaecol Res. 2016;42(1):72–6.  https://doi.org/10.1111/jog.12854. Epub 2015 Nov 4.CrossRefPubMedGoogle Scholar
  32. 32.
    Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function. Pelvic organ prolapse surgery and bladder function. Int Urogynecol J. 2013;24(11):1843–52.  https://doi.org/10.1007/s00192-013-2175-y.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Serati M, Salvatore S, Uccella S, Nappi RE, Bolis P. Female urinary incontinence during intercourse: a review on an understudied problem for women's sexuality. J Sex Med. 2009;6(1):40–8.  https://doi.org/10.1111/j.1743-6109.2008.01055.x.CrossRefPubMedGoogle Scholar
  34. 34.
    Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, Goldstein I, Graziottin A, Heiman J, Laan E, Leiblum S, Padma-Nathan H, Rosen R, Segraves K, Segraves RT, Shabsigh R, Sipski M, Wagner G, Whipple B. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 2000;163(3):888–93.CrossRefGoogle Scholar
  35. 35.
    Rogers RG, Kammerer-Doak D, Darrow A, Murray K, Qualls C, Olsen A, Barber M. Does sexual function change after surgery for stress urinary incontinence and/or pelvic organ prolapse? A multicenter prospective study. Am J Obstet Gynecol. 2006;195(5):e1–4.CrossRefGoogle Scholar
  36. 36.
    Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27(4):306–10.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Enrico Finazzi Agrò
    • 1
    • 2
  • Daniele Bianchi
    • 1
    • 2
  1. 1.Department of Experimental Medicine and SurgeryUniversity of Rome Tor VergataRomeItaly
  2. 2.UOSD Functional Urology, Policlinico Tor VergataRomeItaly

Personalised recommendations