title: Changes in urodynamic measurements and bladder neck position after single-incision trans-vaginal mesh for pelvic organ prolapse.
abstract: OBJECTIVE
  Stress urinary incontinence (SUI) is common in patients with pelvic organ prolapse. This study hypothesized that SUI may be persistent, de novo, or even cured in women after Elevate™ mesh repair alone and that SUI is associated with urodynamic changes and bladder neck position.
  
  
  METHODS
  This secondary analysis included a study cohort of 100 women who underwent Elevate repair. All of them underwent multi-channel urodynamic measurements, 1-h pad test, and bead chain urethrocystography to measure the bladder neck position pre-operatively and at 3 months post-surgery.
  
  
  RESULTS
  Fifty-five women with pelvic organ prolapse were continent and 45 had concomitant SUI. Of the 55 continent women, 19 (35%) had de novo SUI after mesh repair surgery and 5 (9%) subsequently underwent anti-incontinence surgery. Of the 45 incontinent women, 11 (24%) became dry after mesh repair without additional anti-incontinence surgery. Of the remaining 34 (76%) with persistent SUI, 15 (33%) underwent subsequent anti-incontinence surgery. Patients with de novo and persistent SUI had a greater decrease in maximal urethral closure pressure (MUCP) after mesh repair (p = 0.03 and 0.01 respectively). Those cured of SUI also had decreased MUCP (p = 0.12), but the bladder neck position while straining was significantly more elevated after mesh repair (p < 0.01) compared with those with persistent SUI.
  
  
  CONCLUSIONS
  Elevate mesh reinforcement significantly decreases post-operative MUCP, which is associated with SUI, but can elevate the bladder neck position. Correcting a hyper-mobile urethra is associated with treatment of the concomitant SUI.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei, 104, Taiwan.|Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Taipei Medical University, Taipei, Taiwan.|Mackay Medical College, Taipei, Taiwan.
authors.forename: Hui-Hsuan
authors.initials: HH
authors.lastname: Lau
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei, 104, Taiwan.|Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Mackay Medical College, Taipei, Taiwan.
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei, 104, Taiwan.|Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Mackay Medical College, Taipei, Taiwan.
authors.forename: Yung-Wen
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei, 104, Taiwan.|Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Mackay Medical College, Taipei, Taiwan.
authors.forename: Hsuan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei, 104, Taiwan. drthsu571@gmail.com.|Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. drthsu571@gmail.com.|Taipei Medical University, Taipei, Taiwan. drthsu571@gmail.com.|Mackay Medical College, Taipei, Taiwan. drthsu571@gmail.com.
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Su
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011859:Radiography; D053825:Suburethral Slings; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000502:physiology; D014563:Urodynamics
keywords: Pelvic organ prolapse; Stress incontinence; Surgical mesh; Vaginal surgery