Beyond the Abstract - Effects of pelvic organ prolapse repair on urinary symptoms: A comparative study between the laparoscopic and vaginal approach, by Rajeev Ramanah,MD

BERKELEY, CA (UroToday.com) - Pelvic organ prolapse (POP) surgery has a positive impact on most urinary symptoms with improvement in both Urinary Distress Inventory (UDI) and Urinary Distress Inventory (UDI)scores after surgery.

While laparoscopy had a significant efficacy on the difficulty in emptying the bladder, vaginal surgery had a better outcome on SUI symptoms. Nevertheless, both procedures resulted in a high proportion of de novo urinary symptoms making the overall decrease in postoperative urinary symptoms non-significant. Despite this, vaginal surgery improved the impact of these symptoms on daily living after multivariate analysis.

Laparoscopic sacrocolpopexy (LSC) seems to be more effective in decreasing bladder outlet obstruction because the latter is related to the POP which is better corrected by LSC than by vaginal surgery as shown by our anatomic recurrence rate. On the contrary, the vaginal approach was more effective in treating SUI. A possible explanation could be in the surgical technique. The transvaginal procedure consists of a bladder-vaginal dissection up to the suburethral region where the porcine dermis graft is placed. Thus, the graft can provide some support to the bladder neck similarly to the possible effect of a sub-urethral tape used to treat SUI. Neither dissection to the sub-urethral region for the mesh placement nor concomitant Burch colposuspension was performed by laparoscopy, explaining the absence of any potential positive effect on SUI.

Overactive bladder symptoms were only slightly improved by POP repair. Although urinary frequency and urge symptoms decreased by 76% and 50% respectively, only change in frequency rate was statistically significant. Similarly to SUI, better results were observed after vaginal surgery.

Written by:
Rajeev Ramanah MD, Marcos Ballester MD, Elisabeth Chereau MD, Roman Rouzier MD, PhD, and Emile Daraï MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Obstetrics and Gynecology Department
Tenon hospital
University Pierre et Marie Curie
Paris 6, France

 

 

Effects of pelvic organ prolapse repair on urinary symptoms: A comparative study between the laparoscopic and vaginal approach - Abstract

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