Pelvic organ prolapse surgery and bladder function

Baessler, Kaven and Maher, Christopher (2013) Pelvic organ prolapse surgery and bladder function. International Urogynecology Journal, 24 11: 1843-1852. doi:10.1007/s00192-013-2175-y


Author Baessler, Kaven
Maher, Christopher
Title Pelvic organ prolapse surgery and bladder function
Journal name International Urogynecology Journal   Check publisher's open access policy
ISSN 0937-3462
1433-3023
Publication date 2013-11
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s00192-013-2175-y
Open Access Status
Volume 24
Issue 11
Start page 1843
End page 1852
Total pages 10
Place of publication London, United Kingdom
Publisher Springer
Collection year 2014
Language eng
Formatted abstract
Introduction and hypothesis
The aim was to determine the impact of pelvic organ prolapse surgery on bladder function.

Methods

Every 4 years, and as part of the Fifth International Collaboration on Incontinence we reviewed the English-langauage scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. Grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi processed expert opinion. Grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi.

Results

Continent women undergoing anterior compartment prolapse surgery have a lower rate of de novo stress urinary incontinence (SUI) after anterior repair than armed mesh procedures (grade A). Data are conflicting on whether colposuspension should be performed prophylactically in continent women undergoing sacral colpopexy (grade C). No clear conclusion can be made regarding the management of continent women undergoing prolapse surgery without occult SUI. In continent women undergoing POP surgery with occult SUI the addition of continence surgery reduces the rate of postoperative SUI (grade A). In women with prolapse and SUI symptoms prolapse procedures alone (transobturator mesh and anterior repair) are associated with low success rates for SUI. Concomitant continence procedures reduce the risk of postoperative SUI (grade B). Preoperative bladder overactivity may resolve in 40 % undergoing POP surgery and de novo bladder overactivity occurs in 12 %. No valid conclusions regarding voiding dysfunction following POP surgery can be drawn from the available data.

Conclusion
SUI and occult stress urinary incontinence should be treated at the time of prolapse surgery.
Keyword Occult stress urinary incontinence
Continence surgery
Pelvic organ prolapse surgery
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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Created: Sun, 10 Nov 2013, 00:08:02 EST by System User on behalf of Obstetrics & Gynaecology - RBWH