The Effect Of Transvaginal Pelvic Reconstructive Surgery On Lower Urinary Tract Function In The Pelvic Organ Prolapse

Objective：Assess the bladder and urethra function in patients with pelvic organ prolapse byurodynamic testing,combined with the self-evaluation using the Urinary DistressInventory-6(UDI-6),to explore the lower urinary tract function in patients withPOP.Comparing the changes in urodynamic parameters and the questionnaire scoresbefore and after pelvic reconstruction surgery,further investigate the influence ofpelvic reconstruction surgery on lower urinary tract function in the pelvic organprolapse.It maybe provide new ideas and evidences for the treatment in POPcomplicated with urinary incontinence or occult incontinence.Methods：1. The first part The research on lower urinary tract function of the patientswith pelvic organ prolapseThis part,including sixty female outpatients with POP,supply urodynamic testingand UDI-6for assessing the lower urinary tract function of the patients.2. The second part The effect of transvaginal pelvic reconstructive surgery onlower urinary tract function in the pelvic organ prolapseThirty patients with severe POP were underwent urodynamic studies todetermine the volumn at first desire(VFD),volumn at normal desire(VND),volumn atstrong desire(VSD),maximal cystometric capacity(MCC),maximum flow rate(Qmax),postvoidal presidual urine(PVR),maximum urethral pressure (MUP),maximumurethral closure pressure(MUCP),functional urethral length (FUL) at pre-operationand3months after operation.If it is observed to be stress urinary incontinence byusing urodynamic protocol,record the value of Abdomen leak pointpressure(ALPP).In addition,UDI-6was performed to get the questionnaire scores atthe same time.Statistical analysis was performed with SPSS version16.0for Windows. The enumeration data was tested by chi-square test,and the urodynamic parametersbefore and after the surgery were tested by paired t-test. A P-value that was less than0.05was considered statistically significant.The study is to investigate the effect ofTVM on lower urinary tract function in the advanced POP in this way.Results：1. There were60cases of pelvic organ prolapse,18in grade Ⅲ,and42in gradeⅣ.About98.33percent of patients have lower urinary tract symptoms.They areclinically diagnosed as SUI,UUI,MUI,voiding dysfunction and urinary frequency,counting for6.67%,5%,11.67%,33.33%,41.67%.However,USUI,DO,MUI,andvoiding dysfunction were38.33%,11.67%,10%and36.67%respectively byurodynamic testing.The clinical diagnosis has correlation with urodynamicdiagnosis,but consistency was weaker(P=0.005, Kappa value=0.310).Methods Urodynamic testing were carried out for the patients of POP,whosepeak urinary flow rate was16.35±4.46ml/s.There are8cases had a lower urinaryflow rate,16cases with PVR was greater than50ml.The bladder capacity,MUP andMUCP of POP group were higher than those of POP-USUI group,which had nosignificant difference（P＞0.05）.But the FUL of POP-USUI group was shortersignificantly（P﹤0.05）.2. The anatomy cure rate of short-term was100%in the patients of POP,with noacute complications.UDI-6decreased from9.58±2.91preoperatively to2.52±1.58three months postoperatively(P﹤0.05),the urogenital symptoms and quality of lifehas been significantly improved(P﹤0.05).The incidence of lower urinary tractsyptoms in patients was significantly decreased(P﹤0.05).There was a distinctimprovement in voiding dysfunction and urinary frequency(P﹤0.05),but therewere no obvious changes in the syptoms of urgency,SUI and MUI（P＞0.05）.1patient with severe UUI can’t finish the in free uroflometry study.29patientswith POP has a significantly higer maximum flow rate after the surgery.Six out ofthirty patients had urinary retention (PVR≥50ml) before the operation,but no caseoccurred after the surgery.VFD, VND, VSD and MCC were reduced,and all ofthem had significant difference(P<0.05);MUP,MUCP and FUL were elevated,without statistically significant difference.Conclusions：1. Urodynamics,combining with UDI-6patients self-assessment,can comprehensivelyreflect the lower urinary tract function in patients with POP,which is important sig-nificantly for the diagnosis and treatment of urinary tract dysfunction.2. Surgery is effective to POP, whose machanism is to correct the abnormal anato-mical position.Transvaginal placement of surgical mesh for pelvic organ and pro-lapse can make an actual improvement in the lower urinary tract symptoms inpatients with POP.3. It is necessary for the patients with the POP to finish the urodynamic examinationto confirm the lower urinary tract function.4. TVM is a good treatment for severe POP,which can also prevent and treat thepatients merged urinary incontinence well.