Risk factors of for stress urinary incontinence in patients after surgical treatment of pelvic organ prolapse by the vaginal approach

Article authors

George Kasyan

Nataliya V. Tupikina

M. Gvozdev

Malchasyan A.A.

Dmitry Yu. Pushkar

Moscow State University of Medicine and Dentistry, Dept. of Urology, Moscow, Russia

Objective:

To identify possible risk factors of for stress urinary incontinence (SUI) in patients after surgical correction of pelvic organ prolapse (POP) by the vaginal approach relative to the preoperative continence status.

Materials and methods:

This study included 82 women suffering from POP (cystocele grade 2-4 by POP-Q) who underwent transvaginal surgical repair. The study was approved by the local ethics committee, and all patients provided signed informed consent. All patients were submitted to a history taking (Data on BMI, parity, large fetus, usage of hormone replacement therapy, and menopausal status were obtained in all patients. A), a gynecological examination with included cough tests with or without prolapse repositioning by speculum, pessary or manually (POP-Q, the presence of visible pathology urethra), and complex urodynamic study (without repositioning and with repositioning with a cubic silicone pessary).

All patients were operated by vaginal approach. Multivariate logistic regression analysis was used tTo identify the importance of independent risk factors for SUI was used logistic regression analysis.

Results:

Three months after surgery, 41% of the patients (34/82) complained of stress urinary incontinence. No cases of prolapse recurrence were noted within three months.

By comparing the preoperative characteristics in groups after surgery, statistically significant differences were obtained in terms of the cough test without reposition of POP (30% vs 8.3%, p=0.012), cough test with prolapse reposition by speculum (73.5% vs 40%, p= 0.0021), cough test with manual prolapse reposition (50% vs 25%, p=0.0195); borderline statistically significant differences were found forp-value up to 0.1 had a cough test with prolapse reposition by pessary (47% vs 27%, p=0.0636064) and positive transmission of urethral pressure profilometry with a pessary (55% vs 35%, p=0.088709).

According to the logistic regression analysis, independent risk factors for the development of SUI in patients after surgical treatment of POP were the positive cough test without prolapse reposition and with prolapse reposition by speculum before surgical treatment of POP (OR=8,.227523, p=0,0329.033 and OR=5,5610.56, p=0,0212.021, respectively). Also Another possible risk factor was found asfound in this analysis was positive transmission of urethral pressure profilometry with a pessary (OR=3,5188.52, p=0,0310.031), but that contradicteda finding that is inconsistent with the pressure transmission theory of continence.

Conclusion:

The cough tests without prolapse repositioning and with repositioning of POP are important for determining the outcome of surgical treatment in patients suffering from POP.