title: Predictors of persistence of preoperative urgency incontinence in women following pelvic organ prolapse repair.
abstract: OBJECTIVE
  To investigate the predictors of persistence or resolution of preoperative urgency urinary incontinence (UUI) in women following transvaginal mesh (TVM) repair for advanced pelvic organ prolapse (POP).
  
  
  METHODS
  Patients with advanced POP undergoing TVM repair between 2008 and 2013 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, voiding diary, pelvic examination using the POP-quantitation system, and urodynamic testing before and after surgery, and intraoperative cystoscopy. Patient demographics, lower urinary tract symptoms, urodynamic findings, and severity of prolapse were analyzed between women with and without preoperative UUI.
  
  
  RESULTS
  Of 174 patients who underwent TVM repair, 49 (28.2%) had preoperative UUI; after operation, 23 (13.2%) were found to have postoperative UUI and 13 (7.5%) developed de novo UUI. For those 49 patients with preoperative UUI, 10 (20.4%) had persistent UUI and 19 (38.8%) developed de novo stress urinary incontinence postoperatively. The prevalence of preoperative bladder outlet obstruction, preoperative maximal cystometric capacity (MCC) < 300 mL, preoperative severe bladder trabeculation, and duration of POP symptoms > 60 months were significantly higher in patients with persistent UUI than without it. Logistic regression demonstrated that preoperative MCC<300 mL, severe bladder trabeculation, and duration of POP symptoms > 60 months were associated with persistent UUI after prolapse repair.
  
  
  CONCLUSIONS
  For women with identified preoperative risk factors, including MCC<300 mL, severe bladder trabeculation, and POP symptoms > 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: ccjoliang@cgmh.org.tw.
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ling-Hong
authors.initials: LH
authors.lastname: Tseng
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shuenn-Dhy
authors.initials: SD
authors.lastname: Chang
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology; D009130:Muscle, Smooth / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D057234:Preoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology; D001748:Urinary Bladder Neck Obstruction / Q000150:complications; D014550:Urinary Incontinence, Stress / Q000209:etiology; D053202:Urinary Incontinence, Urge / Q000209:etiology*; D014563:Urodynamics / Q000502:physiology
keywords: bladder trabeculation; pelvic organ prolapse; urgency incontinence; urodynamic study