Urodynamic investigation in women with stress urinary incontinence and cystocele

Urodynamic investigation in women with stress urinary incontinence and cystocele

Gordon HoskerGordon Hosker

The Warrell Unit, St Mary’s Hospital, Manchester. UK.

Cystocele can change the Cystocele can change the anatomical relationship anatomical relationship between the bladder and the between the bladder and the urethraurethra

Green - Type IGreen - Type I

Green – Type IGreen – Type I

Green - IntermediateGreen - Intermediate

Green - IntermediateGreen - Intermediate

Green – Type IIGreen – Type II

Green – Type IIGreen – Type II

Filling cystometryFilling cystometry

Prolapse can mask incontinence.Prolapse can mask incontinence.

During filling cystometry, if no During filling cystometry, if no

incontinence is seen, carefully reduce the incontinence is seen, carefully reduce the prolapse with a finger, speculum, or pessary prolapse with a finger, speculum, or pessary and repeat the stress test.and repeat the stress test.

Voiding cystometryVoiding cystometry

Prolapse can kink the urethra.Prolapse can kink the urethra.

This gives the appearance of obstructed This gives the appearance of obstructed voiding on pressure/flow studies. voiding on pressure/flow studies.

Normal pressure-flowNormal pressure-flow

Outflow obstructionOutflow obstruction

Detrusor OveractivityDetrusor Overactivity

More prevalent in large cystocele compared More prevalent in large cystocele compared to moderate cystoceleto moderate cystocele

Some resolution with prolapse surgery?Some resolution with prolapse surgery?

Romanzi et al, 1999Romanzi et al, 1999Golomb et al, 2006Golomb et al, 2006

Nguyen et al, 2001Nguyen et al, 2001

Other factors affecting anatomical relationshipsOther factors affecting anatomical relationships

Not only are anatomical relationships Not only are anatomical relationships influenced by the size of the cystocele influenced by the size of the cystocele itself, they can be affected by:itself, they can be affected by: Degree of bladder fullnessDegree of bladder fullness Patient positionPatient position Other prolapse (e.g. uterine prolapse) Other prolapse (e.g. uterine prolapse)

Recent reviewRecent review

Clinical relevance of urodynamic Clinical relevance of urodynamic investigation tests prior to surgical investigation tests prior to surgical correction of genital prolapse: a literature correction of genital prolapse: a literature reviewreview

Roovers and OelkeRoovers and Oelke

Int Urogynecol J (2007) Int Urogynecol J (2007) 1818 455-460 455-460