title: Size of urogenital hiatus as a potential risk factor for emptying disorders after pelvic prolapse repair.
abstract: OBJECTIVE
  We correlated urogenital hiatus size and levator ani contraction strength with early postoperative emptying disorders. We also determined whether postoperative emptying disorders could be predicted before anti-incontinence procedures and pelvic organ prolapse repair.
  
  
  METHODS
  We retrospectively reviewed the charts of 225 consecutive patients after surgery for pelvic organ prolapse and/or stress urinary incontinence. Urogenital hiatus size was evaluated using pelvic organ prolapse quantification. Levator contraction strength was determined by the Oxford 0 to 5 classification scale. Emptying disorders were defined as post-void residual urine volume greater than 100 ml 48 hours postoperatively and/or discharge home with a Foley catheter or on intermittent self-catheterization.
  
  
  RESULTS
  Median patient age, post-void residual urine volume and urogenital hiatus size were significantly related to levator contraction strength (each p <0.05). Univariate logistic regression analysis revealed a significant association of urogenital hiatus size (p = 0.001), post-void residual urine volume (p = 0.005) and levator contraction strength (p = 0.001) with emptying disorder status. Multivariate logistic regression analysis showed that levator contraction strength (p = 0.001) and post-void residual urine (p = 0.01) were independent predictors of emptying disorders.
  
  
  CONCLUSIONS
  A wide urogenital hiatus, decreased levator ani contraction strength, increasing age and increased post-void residual urine correlated with an increased chance of early postoperative emptying disorders. The most independent predictors of early emptying disorders were decreased levator contraction strength and increased post-void residual urine.
authors: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA. mghafar@umc.edu
authors: Mohamed A
authors: MA
authors: Ghafar
authors: Ralph R
authors: RR
authors: Chesson
authors: Cruz
authors: C
authors: Velasco
authors: Paul
authors: P
authors: Slocum
authors: J Christian
authors: JC
authors: Winters
mesh_terms: D000367:Age Factors; D005260:Female; D006801:Humans; D016015:Logistic Models; D009119:Muscle Contraction; D053580:Muscle Strength; D017773:Pelvic Floor / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010502:Perineum / Q000033:anatomy & histology*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014555:Urination Disorders / Q000503:physiopathology*
keywords: C-index; GH; PB; POP; PVR; SUI; concordance index; female genitalia; pelvic organ prolapse; perineal body; post-void residual urine; prolapse; stress urinary incontinence; urethra; urinary bladder; urination disorders; urogenital hiatus size