title: The effect of prolapse repair on urinary flow rates and the relationship to changes in the ultrasound appearance of the bladder neck.
abstract: OBJECTIVE
  To assess whether specific changes in bladder neck morphology, caused by an anterior repair operation, are associated with resolution of overactive bladder and improved urinary flow rates.
  
  
  METHODS
  Sixty-four women with urgency documented on the urgency perception scale (UPS) underwent an anterior repair. Their preoperative flow studies were compared to those 8 weeks postoperatively. Flow rates were compared in those women who reported improved or cured urgency to those who reported no effect. Resolution of urgency was correlated with the change in bladder neck angulation (posterior urethrovesical angle-PUA).
  
  
  RESULTS
  55% (35/64) women reported no urgency after the anterior repair. A further 19% (12/64) were improved and 26% (17/64) were no better. Patients who were cured or improved showed a significant increase in their flow rates after surgery (mean flow=15 before and 17.6 ml/s after) (Mann-Whitney p=0.04). There was a significant change (increase in the PUA angle/straightening of the angle between the bladder and urethra) from a mean value of 123 degrees (SD 49.3) preoperatively to a mean value of 146.8 (SD 29.2) post operatively (p<0.001). Despite an increase in PUA, this was not correlated with an increase in the maximum flow rate centile (p=0.45, r=0.10).
  
  
  CONCLUSIONS
  An anterior repair results in increased maximum urinary flow rates but this does not correlate to changes in the appearance of the bladder neck.
authors.affiliation: Department of Obstetrics and Gynaecology, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent ME5 7NY, UK. Electronic address: jonathan.duckett@medway.nhs.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duckett
authors.forename: Dorothy
authors.initials: D
authors.lastname: Chakani
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000601:surgery; D014563:Urodynamics; D014596:Uterine Prolapse / Q000601:surgery*
keywords: OAB; Overactive bladder; Pelvic organ prolapse; Ultrasound; Voiding