Voiding

Because little was known about how pelvic organ prolapse impacts bladder and urethral function (despite the fact that many women have problems with both a bulge and bladder symptoms), we compared 3 groups of women that all were planning surgery to treat prolapse.

All of the women underwent bladder testing called urodynamics. One group had stress urinary incontinence (leakage with physical stresses like coughing or sneezing) when the prolapse (bulge) was out, the second group had stress urinary incontinence only when the bulge was pushed back in and the third group never leaked with physical stresses at all. Both of the groups that had stress urinary incontinence (whether the bulge was out or in) were more likely to show unstable bladder contractions during filling on bladder testing. Women with stress urinary incontinence when the prolapse was out had more irritative bladder symptoms (like urgency or frequency) and also more obstructive bladder symptoms (like straining or pushing to void or not feeling empty).

These findings show that women with one bladder problem (stress urinary incontinence) are more likely to have other bladder problems also. However, urodynamic findings of obstruction (based on pressures and volumes) had little relation to symptoms of obstruction or to how well the bladder actually emptied after voiding.

STUDY RESULTS

Nygaard I, Kreder K, Mueller E, Brubaker L, Goode P, Visco A, Weber AM, Cundiff G, Wei J, Pelvic Floor Disorders Network. Does urethral competence affect urodynamic voiding parameters in women with prolapse? Neurourology and urodynamics. 2007; 26(7): 1030-5.

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Mueller E, Wei J, Nygaard I, Brubaker L, Varner E, Visco A, Cundiff GW, Weber AM, Ghetti C, Kreder K. The correlation of voiding variables between non-instrumented uroflowmetery and pressure-flow studies in women with pelvic organ prolapse. Neurourology and urodynamics. 2008; 27(6): 515-21.

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