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Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse: clinical and urodynamic assessments

Liang, Ching-Chung MD; Chang, Yao-Lung MD; Lin, Yi-Hao MD; Chang, Shuenn-Dhy MD

doi: 10.1097/GME.0b013e31827f09a0
Original Articles
Editorial

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.

There is a positive correlation of bladder trabeculation in severe pelvic organ prolapse patients with adverse urinary outcomes. Evaluation of bladder trabeculation should become a prerequisite examination for women undergoing surgery for severe pelvic organ prolapse.

From the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ROC; and College of Medicine, Chang Gung University, Taoyuan, Taiwan ROC.

Received September 28, 2012; revised and accepted November 20, 2012.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Ching-Chung Liang, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan ROC. E-mail: ccjoliang@cgmh.org.tw

© 2013 by The North American Menopause Society.