title: Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele.
abstract: OBJECTIVE
  It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system.
  
  
  METHODS
  The clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15mL/s or postvoid residual urine volume (PVR) above 50mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups.
  
  
  RESULTS
  Of 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent (p=0.040), with lower maximal flow rate (p=0.007) and higher PVR (p=0.034). POP-Q stage was significantly higher (p=0.018), and points Aa and Ba were significantly longer (p=0.005 and p=0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR.
  
  
  CONCLUSIONS
  The prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.
authors.affiliation: Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Yun
authors.initials: JY
authors.lastname: Chae
authors.affiliation: Korea University, College of Medicine, Republic of Korea.
authors.forename: Gil Young
authors.initials: GY
authors.lastname: Park
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Republic of Korea.
authors.forename: Jae Heon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Urology, Dankook University College of Medicine, Republic of Korea.
authors.forename: Hyung Jee
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Korea University Ansan Hospital, Korea University College of Medicine, Republic of Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Korea University Anam Hospital, Korea University College of Medicine, Republic of Korea.
authors.forename: Jeong Gu
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Du Geon
authors.initials: du G
authors.lastname: Moon
authors.affiliation: Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: mamah@hanmail.net.
authors.forename: Mi Mi
authors.initials: MM
authors.lastname: Oh
mesh_terms: D000368:Aged; D052858:Cystocele / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse; D053825:Suburethral Slings; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*; D014563:Urodynamics; D013520:Urologic Surgical Procedures
keywords: Cystocele; Pelvic organ prolapse; Voiding dysfunction