title: Post-reduction stress urinary incontinence rates in posterior versus anterior pelvic organ prolapse: a secondary analysis.
abstract: OBJECTIVE
  Stress incontinence with vaginal prolapse reduction is less common in women with posterior-predominant prolapse (rectocele) compared with those with anterior-predominant prolapse (cystocele).
  
  
  METHODS
  This was a secondary analysis of a cohort of prospectively enrolled women with symptomatic pelvic organ prolapse at or beyond the hymen and prolapse-reduced stress urinary incontinence (SUI) testing. Subjects were included if they had anterior- or posterior-predominant prolapse with at least a 1 cm difference in pelvic organ prolapse quantification (POP-Q) points Ba and Bp (N = 214). We evaluated the prevalence and risk factors of post-reduction SUI between the two groups.
  
  
  RESULTS
  Comparing posterior (n = 45) and anterior (n = 169) prolapse groups, we identified similar rates of post-reduction SUI (posterior: 6/45, 13.3 %; anterior:18/169, 10.7 %; p = 0.52) and SUI without reduction (posterior:4.4 %; anterior:11.2 %; p = 0.26). Maximum prolapse size was slightly larger in anterior than in posterior patients (+3.1 vs +2.0 cm beyond the hymen, p = 0.001), while a higher proportion of posterior subjects reported a prior hysterectomy (p = 0.04). Among posterior subjects, lower maximum urethral closure pressure values (MUCP; p = 0.02) were associated with post-reduction SUI. In contrast, among anterior-predominant prolapse, larger prolapse measured at POP-Q point Ba (p = 0.003) and maximum POP-Q measurement (p = 0.006) were each associated with higher rates of post-reduction SUI and were highly correlated with each other (R = 0.90).
  
  
  CONCLUSIONS
  We observed similar rates of post-reduction SUI in women with anterior- and posterior-predominant pelvic organ prolapse. Factors affecting the anterior and posterior prolapse groups differed, suggesting different mechanisms of continence protection. These findings suggest that reduction incontinence testing for operative planning would be as relevant to posterior-predominant prolapses as it is to anterior prolapse.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, Ann Arbor, MI 48109, USA. toviasmith@gmail.com
authors.forename: Tovia M
authors.initials: TM
authors.lastname: Smith
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D052858:Cystocele / Q000150:complications* / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000145:classification* / Q000150:complications* / Q000601:surgery; D015995:Prevalence; D011446:Prospective Studies; D020047:Rectocele / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D014521:Urethra / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*