Urodynamic parameter to predict stress urinary incontinence after laparoscopic sacrocolopexy
Jimmy Nomura (1), Yuko Yoshio (1), Shino Tokiwa (1), Mika Nagae (1), Yugo Sawada (1), Tokumasa Hayashi (1), Bobby Achila (1), Pattiya Nutthachote (1), Indra Indra
(1) Kameda Medical Center, Urogynecology Center, Kamogawa ciy, Japan
Pelvic organ prolapse (POP) is frequently coexisted with stress urinary incontinence (SUI). Although SUI is not demonstrated preoperatively.it develops after POP repair in some patients (de novo SUI). However little is known about which factors can predict the condition of postoperative SUI. In this study, we examine predictor to determine postoperative SUI after laparoscopic sacrocolpopexy (LSC).
Seventy-five POP patients who underwent LSC were included. An urodynamic evaluation was performed both pre and postoperatively and parameters were compared between patients with and without urinary incontinence at 6 months after LSC. SUI was evaluated by questionnaire and inquiry.
Preoperatively, 32 patients showed SUI and 43 patients showed no SUI. Among 32 patients with SUI preoperatively, 23 patients continued to show SUI and 9 patients show no SUI postoperatively. Among 43 patients with no SUI preoperatively, 30 patients continued to show no SUI and 9 patients showed de novo SUI postoperatively. Among all 75 patients, they were divided into postoperative SUI and no SUI groups. The urodynamic parameters were compared in two groups. Preoperative maximum urethral closure pressure (MUCP) was significantly lower in the postoperative SUI group compared to no SUI group (30.8 vs. 44.5 cm H2O, p = 0.006). In addition, among 43 cases with preoperative no SUI, MUCP was significantly lower in postoperative SUI group compared to that in postoperative no SUI group (37.6 c vs. 50.7 cm H2O, p = 0.019). Preoperative first desire to void (FDV) and maximum desire to void (MDV) were also significantly lower in the postoperative SUI group compared to no SUI group (FDV: 171.4.5±100.6 vs. 155.7±92.9ml, P=0.019, MDV: 278.2±138.5 vs.248.9±106.6ml, P=0.029).
MUCP was the most discriminative parameter to predict postoperative SUI condition after LSC. In addition, bladder capacity may play a role in predicting postoperative SUI.