title: Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse: clinical and urodynamic assessments.
abstract: OBJECTIVE
  Bladder trabeculation (BT) is a secondary result of bladder outlet obstruction (BOO), which may result from severe pelvic organ prolapse (POP) and cause lower urinary tract symptoms (LUTS). This study was conducted to investigate the relationship among clinical manifestations, urodynamic findings, and BT in women with severe POP.
  
  
  METHODS
  We reviewed the medical records of patients with stage 3 or stage 4 POP who underwent prolapse surgical operation in a tertiary hospital between 2005 and 2011. All patients received preoperative evaluations, including urodynamic studies, cystoscopy, and a structured urogynecological questionnaire. Demographics, LUTS, pelvic floor symptoms, and urodynamic findings were compared between women with BT and women without BT.
  
  
  RESULTS
  Of the 308 women included, 54.9% had BT and 12.7% were diagnosed with BOO (maximal flow rate <12 mL/s; detrusor pressure at maximal flow >20 cm H2O). Mean age, prevalence of urgency, urge incontinence, voiding difficulty, detrusor overactivity, and postvoid residual greater than 100 mL were significantly higher in women with BT than in women without BT. In addition, severe BT had significantly higher prevalences of detrusor overactivity, BOO, lower maximal cystometric capacity, urge incontinence, and anterior vaginal prolapse. Logistic regression demonstrated that detrusor overactivity was the only variable associated with BT.
  
  
  CONCLUSIONS
  More than half of the women with severe POP have BT, which, when compared with women without BT, indicates higher incidences of LUTS, detrusor overactivity, and urinary retention. An objective evaluation of BT should become a prerequisite examination for women with severe POP who would undergo prolapse surgical operation.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ROC. ccjoliang@cgmh.org.tw
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Lin
authors.forename: Shuenn-Dhy
authors.initials: SD
authors.lastname: Chang
mesh_terms: D000368:Aged; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D017698:Postmenopause; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000453:epidemiology; D053201:Urinary Bladder, Overactive / Q000453:epidemiology / Q000209:etiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D014563:Urodynamics