Is Preoperative Urodynamics Essential for Women With Pelvic Organ Prolapse
Condition: Urogenital Prolapse
MeSH terms: Prolapse; Pelvic Organ Prolapse
Study type: Observational

Summary: 
      urodynamic investigation when added in the diagnostic work-up of women with lower urinary
      tract dysfunction with POP is debatable.

      This study was planned to determine the usefulness of preoperative urodynamic study in
      improving urological outcome following surgery in women with pelvic organ prolapse and
      urinary tract dysfunction.
    

Detailed description: 
      60 patients, fulfilled the selection criteria were counseled and informed about the trial
      protocol and a written consent according to declaration of Helsinki was signed. Participants
      were randomly assigned following simple randomization procedures (computerized random
      numbers) to group (1) or group (2). Each group consisted of 30 patients. All participants had
      been thoroughly evaluated by history and examination. A standardized questionnaire was
      obtained to evaluate the symptoms of stress urinary incontinence, urge urinary incontinence
      and obstructive symptoms. Clinical staging of pelvic organ prolapse by POP Q Staging.
      Ultrasound examination had been also carried out to rule out any pelvic pathology. Patients
      had completed a 3-day bladder diary (frequency volume chart) to assist in arriving at an
      urodynamic diagnosis. Urinalysis was performed. Only patients allocated for group 1 were
      subjected to urodynamic studies before surgical intervention and then corrective procedures
      for POP had been done .The Urodynamic studies carried out were : uroflowmetry and cystometry.
      The Uroflowmetry was performed by the gravimeter method, where maximum flow rate, average
      flow rate, voided volume and residual urine was measured. Maximum flow rate ≤15 ml/sec,
      and/or residual urine of more than 50 ml or 10% of voided volume in a bladder filled with a
      minimum of 150 ml was taken as cut off to detect abnormal voiding. Cystometric parameters
      which indicated normal bladder function were first desire to void between 150 and 200 ml,
      capacity (taken as strong desire to void) of greater than 400 ml, detrusor pressure rise on
      filling of less than 15 mm H2O per 500 ml infused, absence of detrusor contractions, no
      leakage on coughing, no significant pain on filling and finally a detrusor pressure rises on
      voiding (maximum voiding pressure) of less than 50 cm H2O, with a peak flow rate of more than
      15 ml/s for a voided volume over 150 ml. Urodynamic stress incontinence was diagnosed when
      urethral leakage was seen with increased abdominal pressure, in the absence of detrusor
      contractions. Detrusor over activity was diagnosed when the patient has involuntary detrusor
      contractions during filling with or without leakage which may be spontaneous or provoked. All
      participants were followed-up with same questionnaire and clinical examination after 12 weeks
      post operatively.
    

Intervention name(s): urodynaemic studies
Intervention type(s): Diagnostic Test
Intervention description(s): The Urodynamic studies carried out were : uroflowmetry and cystometry. The Uroflowmetry was performed by the gravimetric method Detrusor over activity was diagnosed when the patient has involuntary detrusor contractions during filling with or without leakage which may be spontaneous or provoked,
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        performed in Shatby Maternity University hospital, which is considered the largest hospital
        in Alexandria city in Egypt offering obstetrical and gynecological services for more than
        three millions females
      
Keywords: pelvic organ prolapse,; Urodynamics