The incidence of low-pressure urethra as a function of prolapse-reducing technique in patients with massive pelvic organ prolapse (maximum descent at all vaginal sites).
OBJECTIVE
Our aims were to compare several prolapse-reducing techniques during urodynamic evaluation and prospectively evaluate their usefulness in identifying the incidence of low urethral closure pressure in continent patients with massive prolapse.


METHODS
This preoperative, prospective, repeated-measures urodynamic study evaluated the maximum urethral closure pressure with the use of four different techniques in 30 consecutive continent patients with grade 4 prolapse at all vaginal sites. Twenty patients with grade 0 prolapse served as the control group. All patients from the prolapse group underwent surgical treatment and were followed up clinically for a minimum of 1 year.


RESULTS
Use of the Scopette (Birchwood Laboratories, Eden Prairie, Minn.) reduction technique to reduce the prolapse in a linear orientation during multichannel urodynamics revealed a 56% incidence of low-pressure urethra and an overall genuine stress urinary incontinence of 83% in patients with massive pelvic organ prolapse but without clinical urinary incontinence.


CONCLUSIONS
There may be an increased indication for sling urethropexy in patients with massive prolapse.
Veronikis
D K
DK
Division of Urogynecology and Reconstructive Pelvic Surgery, Vincent Memorial Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Nichols
D H
DH
Wakamatsu
M M
MM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011312:Pressure; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D014521:Urethra / Q000503:physiopathology; D014522:Urethral Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014563:Urodynamics; D014596:Uterine Prolapse / Q000601:surgery*