Abstract
Introduction: The aim of the study was to determine the interactive effect of pelvic organ prolapse (POP) on voiding dynamics of female patients with urodynamic stress urinary incontinence (USUI). Free urine flow curve pattern (FUFCP) criterion was implemented to bladder outlet obstruction (BOO) and detrusor underactivity definitions. Methods: Patient file review of 362 female patients with non-neurogenic USUI was conducted, and after exclusion criteria 178 female patients with pure USUI were eligible for the study. Patients with USUI were divided into three groups: group 1 without (w/o) prolapse, group 2 with mild, and group 3 with moderate/severe prolapse. The patient characteristics, pressure flow findings, and FUFCPs were compared between three groups. Results: Of 178 patients with a median age of 55 (47–65), 61 (34.3%) did not have any prolapse, 95 (53.4%) had mild, and 22 (12.3%) had moderate/severe POP (p = 0.571). No statistically significant difference was determined between pressure-flow numeric values in USUI patients with or w/o POP (p = 0.104 for Qmax and p = 0.587 for PdetQmax). Ordinal logistic regression analysis results showed that smaller amount of voided volume during free urine flow (p = 0.037), non-bell-shaped FUFCP (p = 0.006), larger amount of post-void residual urine volume (p = 0.001), and more frequent urodynamic diagnosis of BOO (p = 0.046) were the independent significant urodynamic features of the patients in group 3. Bell-shaped pattern was the most frequent pattern in group 1 (62.3%) while this pattern was infrequent in group 3 (18.2%). Conclusions: Using the new FUFCP criterion in the present study, a marked shift from bell-shaped to prolonged/intermittent patterns with increasing POP severity was evident. Although detrusor pressure metrics changed little, patients with coexistent USUI and moderate/severe POP had more frequent urodynamic BOO, supporting the construct validity of incorporating FUFCP into the evaluation.
