1863 PREDICTORS OF IMPROVEMENT IN LOWER URINARY TRACT SYMPTOMS AFTER SACROCOLPOPEXY (2011)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111863 PREDICTORS OF IMPROVEMENT IN LOWER URINARY TRACT SYMPTOMS AFTER SACROCOLPOPEXY Leslie Rickey, and James Minor Leslie RickeyLeslie Rickey Baltimore, MD More articles by this author , and James MinorJames Minor Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1945AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The relationship between pelvic organ prolapse (POP) and overactive bladder symptoms is not well understood. We sought to identify predictors of improvement of bothersome irritative urinary symptoms in women undergoing sacrocolpopexy for treatment of POP. METHODS The Colpopexy and Urinary Reduction Efforts trial randomized 322 continent women with Stage II POP to undergo sacrocolpopexy with or without a Burch urethropexy. At baseline, 169 (55%) women reported at least 1 bothersome irritative urinary symptom, and these women were the subjects of this analysis. Demographic data and validated measures of symptom severity and quality of life were collected, including the Urogenital Distress Inventory (UDI), the Medical, Epidemiologic and Social Aspects of Aging questionnaire (MESA), the Hunskaar severity scale, and the Short Form Health Survey (SF-36). All participants underwent urodynamic testing (UDS) and anatomic assessment. Cluster analysis was performed to identify distinct categories of patients based on their UDI-I responses. Logistic regression models were fit to predict improvement in irritative urinary symptoms at the 12-month follow-up. RESULTS Among subjects who reported bothersome irritative symptoms prior to surgery, 126 (74.6%) no longer reported bothersome symptoms 12 months after surgery. Urinary frequency improved in 87% of women, urgency improved in 89%, urge urinary incontinence improved in 94%, and nocturia improved in 70% of women. Baseline factors associated with lack of improvement included lower SF-36 physical component summary [OR (CI) = 0.92 (0.86, 0.98), p=.0043], increased parity [OR 1.99 (1.35, 3.11), p=.0004], leakage with cough during UDS (p=0.0391), and UDI-I cluster group (p=0.0028). Using the Hunskaar scale, patients with “very severe/severe” leakage had almost 3 times the chance of persistent irritative symptoms compared to the “none” or “slight/moderate” groups (p=.0029). Age, race, BMI, hormonal status, detrusor overactivity, Burch, POP-Q stage, and point Aa did not predict improvement in bothersome irritative symptoms. CONCLUSIONS Irritative urinary symptoms improve in a large percentage of women undergoing sacrocolpopexy for POP. Patients who report better physical health and fewer vaginal deliveries are more likely to report improvement of bothersome symptoms. UDI-I response patterns also predicted improvement in irritative LUTS. Cluster analysis may be a valuable tool for exposing distinct patient profiles that can affect treatment outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e747 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leslie Rickey Baltimore, MD More articles by this author James Minor Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...