#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Relationship between urethrovesical junction mobility changes and postoperative progression of stress urinary incontinence following sacrospinous ligament fixation – a subanalysis of a multicentre randomized study


Authors: D. Gágyor 1 ;  Radovan Pilka 2 ;  A. Benická 2 ;  V. Kališ 3 ;  Z. Rušavý 3 ;  L. Krofta 4 ;  Němec M. 5;  Jaromír Mašata 6
Authors place of work: Gynekologické oddělení, Nemocnice TGM Hodonín, p. o. 1;  Porodnicko-gynekologická klinika LF UP a FN Olomouc 2;  Gynekologicko-porodnická klinika LF UK a FN Plzeň 3;  Ústav pro péči o matku a dítě, Praha 4;  Gynekologicko-porodnické oddělení, Nemocnice ve Frýdku-Místku, p. o. 5;  Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze 6
Published in the journal: Ceska Gynekol 2022; 87(3): 156-161
Category: Original Article
doi: https://doi.org/10.48095/cccg2022156

Summary

Objectives: The study aimed to assess the relationship between urethrovesical junction (UVJ) descent and development of de novo stress urinary incontinence (SUI) and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse using the method of sacrospinal fixation (SSF). This was a secondary analysis of the SAME prospective randomized multicentre study (reg. no. NCT03053479) comparing three approaches to surgery for apical defects – sacropexy, SSF and transvaginal mesh. Methods: The subanalysis included 81 patients with apical defects managed by SSF, either right-sided (N = 14, 17.3%) or bilateral (N = 67, 82.7%). Postoperative follow-up was assessed at 3 months (N = 59), 12 months (N = 47) and 24 months (N = 30). UVJ mobility at rest and with maximum effort, the Valsalva manoeuvre was determined using a standardized 3D/ 4D transperineal ultrasound protocol proposed by Dietz et al. De novo SUI and postoperative progression of preexisting SUI were ascertained from history. Results: Preoperative demographic data (N = 81) were as follows: BMI 27.3 kg/ m2 (16.8–44.5), age 67.0 years (31–85), and parity 2 (1–6). Concomitant anterior repair was performed in 65.4%. Postoperative progression of SUI was 45.8% at 3 months, 21.3% at 12 months, and 23.3% at 24 months. There were significant differences between preoperative and postoperative UVJ descent values at 3, 12 and 24 months (P < 0.0001). Correlations between UVJ descent at 3, 12 and 24 months postoperatively and de novo SUI or progression of preexisting SUI at 3, 12 and 24 months postoperatively were not statistically significant (P = 0.051–0.883). Correlations between differences (preoperative UVJ descent minus UVJ descent at 3, 12 and 24 months postoperatively) and de novo SUI or progression of preexisting SUI at 3, 12 and 24 months postoperatively were not statistically significant (P = 0.691–0.779). Conclusions: The study showed significant changes in UVJ descent values preoperatively and at 3, 12 and 24 months after SSF. There were no significant correlations between UVJ descent and de novo SUI and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse at 3-, 12- and 24-month follow-up. There were no signifi cant correlations between differences (preoperative UVJ descent minus UVJ descent at 3, 12 and 24 months postoperatively and de novo SUI and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse at 3-, 12- and 24-month follow-up.

Keywords:

stress urinary incontinence – pelvic organ prolapse – sacrospinous ligament fixation – pelvic floor ultrasound – urethrovesical junction mobility


Zdroje

1. Alas AN, Chinthakanan O, Espaillat L et al. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. Int Urogynecol J 2017; 28(4): 583–590. doi: 10.1007/ s00192-016-3149-7.

2. Drahoradova P, Martan A, Svabik K et al. Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures. Med Sci Monit 2011; 17(2): CR67–CR72. doi: 10.12659/ msm.881389.

3. Frigerio M, Manodoro S, Cola A et al. Risk factors for persistent, de novo and overall overactive bladder syndrome after surgical prolapse repair. Eur J Obstet Gynecol Reprod Biol 2019; 233: 141–145. doi: 10.1016/ j.ejogrb.2018.12.024.

4. Khayyami Y, Elmelund M, Lose G et al. De novo urinary incontinence after pelvic organ prolapse surgery – a national database study. Int Urogynecol J 2020; 31(2): 305–308. doi: 10.1007/ s00192-019-04041-5.

5. Fialkow MF, Newton KM, Lentz GM et al. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(3): 437–440. doi: 10.1007/ s00192-007-0459-9.

6. Muŋiz KS, Pilkinton M, Winkler HA et al. Prevalence of stress urinary incontinence and intrinsic sphincter defi ciency in patients with stage IV pelvic organ prolapse. J Obstet Gynaecol Res 2021; 47(2): 640–644. doi: 10.1111/ jog.14574.

7. Haylen BT, de Ridder D, Freeman RM et al. An International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21(1): 5–26. doi: 10.1007/ s00192-009-0976-9.

8. Neuman M, Masata J, Hubka P et al. Sacrospinous ligaments anterior apical anchoring for needle-guided mesh is a safe option: a cadaveric study. Urology 2012; 79(5): 1020–1022. doi: 10.1016/ j.urology.2012.01.045.

9. Sauerwald A, Bruns I, Peveling B et al. Is standardised vaginal sacrospinous ligament fixation a safe teaching procedure for residents? Int Urogynecol J 2011; 22(3): 293–298. doi: 10.1007/ s00192-010-1341-8.

10. Aigmueller T, Riss P, Dungl A et al. Long-term follow-up after vaginal sacrospinous fixation: patient satisfaction, anatomical results and quality of life. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(7): 965–969. doi: 10.1007/ s00192-008-0563-5.

11. Tseng LH, Chen I, Chang SD et al. Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery – a systemic review. Taiwan J Obstet Gynecol 2013; 52(3): 311–317. doi: 10.1016/ j.tjog.2012.11.002.

12. Bai SW, Kwon JY, Chung DJ et al. Differences in urodynamic study, perineal sonography and treatment outcome according to urethrovesical junction hypermobility in stress urinary incontinence. J Obstet Gynaecol Res 2006; 32(2): 206–211. doi: 10.1111/ j.1447-0756.2006.00378.x.

13. Lo TS, Bt Karim N, Nawawi EA et al. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J 2015; 26(9): 1313–1319. doi: 10.1007/ s00192-015-2685-x.

14. Svabik K, Martan A, Masata J et al. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol 2014; 43(4): 365–371. doi: 10.1002/ uog.13305.

15. Dietz HP. Pelvic fl oor ultrasound: a review. Am J Obstet Gynecol 2010; 202(4): 321–334. doi: 10.1016/ j.ajog.2009.08.018.

16. Martan A, Mašata J, Halaška M. Ultrazvukové vyšetření dolního močového ústrojí užen. Ceska Gynekol 1997; 62(6): 350–352.

17. Masata J, Svabik K, Martan A et al. What ultrasound parameter is optimal in the examination of position and mobility of urethrovesical junction? Ceska Gynekol 2005; 70(4): 280–285.

18. Svabik K, Hubka P, Masata J et al. How accurate are we in urethral mobility assessment? Comparison of subjective and objective assessment. Ceska Gynekol 2018; 83(4): 257–262.

19. Moosavi SY, Samad-Soltani T, Hajebrahimi S et al. Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: a systematic review. Turk J Urol 2020; 46(6): 427–435. doi: 10.5152/ tud.2020.20291.

20. Başer E, Seçkin KD, Kadiroğullari P et al. The effect of sacrospinous ligament fixation during vaginal hysterectomy on postoperative de novo stress incontinence occurrence: a prospective study with 2-year follow-up. Turk J Med Sc 2020; 50(4): 978–984. doi: 10.3906/ sag-2005-117.

21. Wu PC, Wu CH, Lin KL et al. Predictors for de novo stress urinary incontinence following pelvic reconstruction surgery with transvaginal single- incisional mesh. Sci Rep 2019; 9(1): 19166. doi: 10.1038/ s41598-019-55512-0.

22. Pizzoferrato AC, Nyangoh Timoh K, Bader G et al. Perineal ultrasound for the measurement of urethral mobility: a study of inter- and intraobserver reliability. Int Urogynecol J 2019; 30(9): 1551–1557. doi: 10.1007/ s00192-019-03933-w.

23. Lizaola-Diaz de Leon H. The "normal" mobility of the urethra. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(2): 167–168. doi: 10.1007/ s00192-007-0503-9.

24. Vytiskova T, Masata J, Svabik K et al. Classification of descent and mobility of urethrovesic junction in women with stress urinary incontinence – an ultrasound study. Ceska Gynekol 2018; 83(3): 188–194.

25. Martan A, Masata J, Svabik K et a. Correlation between urethral mobility and maximal urethral closure pressure and Valsalva leak-point pressure in women with urinary stress incontinence. Ceska Gynekol 2005; 70(2): 123–128.

26. Novakova Z, Masata J, Svabik K. Is it possible to estimate urethral mobility based on maximal urethral closure pressure measurements? Ceska Gynekol 2019; 84(2): 115–120.

27. Martan A, Masata J, Petri E et al. Weak VLPP and MUCP correlation and their relationship with objective and subjective measures of severity of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18(3): 267–271. doi: 10.1007/ s00192-006-0140-8.

Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Článok vyšiel v časopise

Czech Gynaecology

Číslo 3

2022 Číslo 3
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#