title: Does urethral competence affect urodynamic voiding parameters in women with prolapse?
abstract: OBJECTIVE
  To (1) compare voiding parameters and (2) correlate symptoms and urodynamic findings in women with pelvic organ prolapse (POP) and varying degrees of urethral competence.
  
  
  METHODS
  We compared three groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the Colpopexy and Urinary Reduction Efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI) during prolapse reduction. Group 3 participants (n = 74), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms and planned sacrocolpopexy. Participants completed standardized uroflowmetry, pressure voiding studies, and validated symptom questionnaires.
  
  
  RESULTS
  Subjects' median age was 61 years, median parity 3 and 87% had stage III or IV POP. Fourteen percent of women in Group 3 demonstrated USI without, and 70% with, prolapse reduction. Women in Groups 2 and 3 had more detrusor overactivity (DO) than Group 1 (17 and 24% vs. 6%, P = 0.02) and detrusor overactivity incontinence (DOI) (15 and 8% vs. 0%, P = 0.004). Based on the Blaivis-Groutz nomogram, 60% of all women were obstructed. Post-void residual volume (PVR), peak flow rate, detrusor pressure at peak flow, voiding mechanisms, voiding patterns, obstruction and urinary retention did not differ among groups. Women in Group 3 had higher irritative and obstructive symptom scores than Group 1 or 2; neither score differed by presence of DO nor obstruction, respectively.
  
  
  CONCLUSIONS
  Women with POP have significant rates of urodynamic obstruction and retention, independent of their continence status. Symptoms of obstruction and retention correlate poorly with urodynamic findings.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah College of Medicine, Salt Lake City, UT 84132, USA. Ingrid.nygaard@hsc.utah.edu
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nygaard
authors.forename: Karl
authors.initials: K
authors.lastname: Kreder
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mueller
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Patricia
authors.initials: P
authors.lastname: Goode
authors.forename: Anthony
authors.initials: A
authors.lastname: Visco
authors.forename: Anne M
authors.initials: AM
authors.lastname: Weber
authors.forename: Geoff
authors.initials: G
authors.lastname: Cundiff
authors.forename: John
authors.initials: J
authors.lastname: Wei
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D014521:Urethra / Q000502:physiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology; D014554:Urination / Q000502:physiology*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000150:complications / Q000503:physiopathology*; D014621:Vagina / Q000601:surgery