ICS 2018: Correlation of Pelvic Organ Prolapse Staging with Lower Urinary Tract Symptoms

Philadelphia, PA (UroToday.com) Literature has revealed that symptoms of pelvic organ prolapse (POP) are an independent risk of an asymptomatic overactive bladder. Anterior vaginal wall prolapse is associated with overactive bladder and directly correlated to overactive bladder severity. However, different anterior vaginal wall prolapse stages might cause divergent effects on urinary incontinence. Chin-Den Chen, MD and team studied correlations of POP staging in different compartments with lower urinary tract symptoms (LUTS).

From January 2016 to December 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were recruited into this study.  We excluded 33 patients who had a hysterectomy. In total, 252 patients’ demographic data, LUTS and POP stages were analyzed. Different stages of different compartments (anterior, cervix and posterior) of POPs according to IUGA and ICS terminology (as standardized in 1996) were re-grouped into four categories as stage 0, 1, 2, and 3 (including stage 4 because of a limited number of patients in stage 4). Pearson correlation coefficient was used to find correlations between different compartments of POP and LUTS (stress urinary incontinence, overactive bladder and voiding difficulty). General linear regression was used to evaluate factors associated with the occurrence of overactive bladder. A p value less than 0.05 was considered as a significant difference.

Only the Pearson correlation of overactive bladder and different compartments of POP were equal to or larger than 0.3 (moderate relationship; the anterior vaginal wall was -0.3116, cervix was -0.2954 and the posterior vaginal wall was -0.3779; all p < 0.05). Further, they found that stage 1 of anterior vaginal wall prolapse significantly increased (39.6%) the occurrence of overactive bladder compared to no prolapse. However, posterior compartment prolapse had a lower occurrence of overactive bladder (stage 1 reduced by 35.8%, stage 2 reduced by 31.2%, stage 3 reduced by 58% compared to no posterior vaginal wall prolapse (Table 1).

 Their results imply that only stage 1 of anterior vaginal wall prolapse is associated with an increase in overactive bladder and posterior compartment prolapse may reduce the occurrence of overactive bladder. Stress urinary incontinence and voiding difficulty had no correlation to any compartment of POP.

They concluded that the correlation between POP with LUTS is weak except for overactive bladder.

Presented by: Chin-Den Chen, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung Taiwan
Authors: Liao Y, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung Taiwan, NG S, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung Taiwan 2 Institute of Medicine, Chung Shan Medical University, Taichung Taiwan

Written by: Bilal Farhan, MD; Clinical Instructor, Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine Medical Center, Twitter: @Bilalfarhan79 at the 2018 ICS International Continence Society Meeting - August 28 - 31, 2018 – Philadelphia, PA USA

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