Pelvic Organ Prolapse

Fig. 11.1

(a, b) Urodynamic s tracings for patient 1; (a) without vaginal packing; (b) with vaginal packing

Findings

For Fig. 11.1a (without vaginal packing):

Filling Phase

CMG: Increased first desire and first sensation
Bladder compliance: Normal
Detrusor overactivity: No
Stress incontinence: No
Maximum cystometric capacity: 250 mL

Voiding Phase

Max voiding detrusor pressure: 21 cm H₂O with void
PdetQmax: 13 cm H₂O, flow at 9 mL/s
Abdominal strain: No
EMG: No DESD or abnormal patterns noted
Impression: Increased sensation and no SUI

For Fig. 11.1b (with vaginal packing):

Filling Phase

CMG: Early first desire and first sensation
Bladder compliance: Normal
Detrusor overactivity: No
Stress incontinence: Yes
Leaks urine with Valsalva/coughs: Yes
Lowest leak point pressure: 72 cm H₂O at 250 mL
Maximum cystometric capacity: 350 mL

Voiding Phase

Max voiding detrusor pressure: 14 cm H₂O with void
PdetQmax: 14 cm H₂O, flow at 24 mL/s
Abdominal strain: No
EMG: No DESD or abnormal patterns noted
Impression: Early sensation, urodynamic occult SUI reduction of POP

11.4.1.5 Treatment Options

On PE the patient had recurrent stage 3 anterior POP, recurrent stage 2 posterior prolapse, and stage 3 apical prolapse. On UDS the patient demonstrated urodynamic occult SUI. Given that the patient wanted definitive surgical management, sacrospinous ligament fixation, abdominal/robotic sacrocolpopexy, and colpocleisis with a concomitant mid-urethral sling were discussed with the patient. Given that the patient no longer desired to be sexually active, she underwent a colpocleisis and MUS.

11.4.2 Patient 2

11.4.2.1 History

The patient is an 80-year-old female s/p TVH in 2000 and right radical nephrectomy in 2007 for RCC with a 2-year history of a vaginal bulge that has progressively worsened over the last month. Patient reports that since being able to see the bulge her stream is slow and at times she does not feel like she empties to completion. She denies SUI and urgency incontinence but does report an increase in diurnal frequency (daytime frequency × 12 and nocturia × 4) associated with a worsening of the vaginal bulge.

11.4.2.2 Physical Examination

General appearance: Obese, no acute distress, and well nourished
Psych: No signs of depression, anxiety, or agitation
Neuro: Gait normal, no UE or LE weakness
Skin/lymph: No rash and lesions
Respiratory effort: Normal, no labored breathing, and lungs CTAB
Cardiovascular: RRR w/no appreciable murmur, +LE edema
External genitalia: + atrophy
Urethral meatus: No masses or caruncle
Urethra: No masses or diverticulum
Urethral angle: >30°, NO SUI with Valsalva or cough with or without POP reduced
POP-Q: Aa = + 2, Ba = +3, C = 0, gh = 3, pb = 2, tvl = 7 Ap = −2, Bp = −2, and D = N/A