NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Subjective and Objective Voiding Dysfunction in Grade 4 Cystocele: Analysis of 350 patients.
M. Grey Maher, MD1, Arthur Mourtzinos, MD2, Larissa V. Rodriguez, MD3, Shlomo Raz, MD3
1The Urology Center, New Haven, CT, USA, 2The Lahey Clinic, Burlington, MA, USA, 3UCLA, Los Angeles, CA,

Background: Women with high grade pelvic organ prolapse present with a multiplicity of voiding symptoms. Prior series have reported on the variation in symptoms between different grades of anterior vaginal wall prolapse. Overall urinary symptoms and concomitant urodynamic evaluations of patients with grade 4 cystocele have not been systematically characterized. The purpose of this study was to prospectively evaluate the incidence, severity, and distribution of voiding dysfunction in patients with a Grade 4 cystocele.
Methods: We prospectively evaluated patients from 2001-2004 who presented with a Grade 4 cystocele. All patients underwent clinical examination, and cystoscopy. The subjective incidence of stress urinary incontinence (SUI), urge incontinence (UI), and obstructive voiding (OV) was evaluated using the SEAPI Incontinence Classification System. Video urodynamics UDS) results were compared to the subjective symptoms.
Results: 351 patients had a complete evaluation, and SEAPI results. Mean age was 66. 22.5% complained of all three symptoms: SUI, UI, and OV. The most common complaint was OV in 59% of patients. On multivariate analysis age was the main predictor of symptom distribution for SUI. It was the most common symptom in the 4th decade (p=0.0016) and its incidence peaked in the 5th decade (p = 0.0453.) UI was reported in 176 patients (50%). Advancing age and not degree of prolapse was the main predictor of symptoms of severe UI. 21% of 30-40yo had UI, whereas, 54% of 60 year olds complained of UI, and 62%of patients 80 and older had UI, (p<0.001). In the patients who underwent UDS, there was discordance in the report and grading of subjective symptoms as compared to the objective results for SUI (p= 0.0001), OV (p=0.0069), and UI (p=0.001.)
Conclusions: A subjective urinary complaint in patients with grade 4 cystocele is extremely common. The incidence and severity of symptoms is higher in older patients except the incidence of SUI which peaks in the 5th decade. Although the prolapse itself might play a role in the etiology of these voiding symptoms, other factors, such as age, may independently impact who is at risk of subjectively experiencing a particular symptom. This might explain why overall success rates and satisfaction after prolapse repair varies in different age groups. The discrepancy between the subjective report of voiding dysfunction symptoms and the objective results on video urodynamics warrants further investigation.


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