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Reduction of moderate‐to‐large cystocele during urodynamic evaluation using a vaginal gauze pack: 8‐year experience
Author(s) -
GILLERAN JASON P.,
LEMACK GARY E.,
ZIMMERN PHILIPPE E.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05905.x
Subject(s) - medicine , surgery , bladder outlet obstruction , urethra , valsalva maneuver , urology , blood pressure , prostate , cancer
OBJECTIVE To determine the effect of cystocele reduction by a vaginal gauze pack on urodynamic studies (UDS). PATIENTS AND METHODS UDS from consecutive women with symptomatic pelvic organ prolapse were reviewed. The protocol included a ‘fill‐void’ study with a vaginal gauze pack, and then repeated without the pack. Tracings were categorized based on filling cystometrograms (CMGs) and pressure‐flow studies (PFS). RESULTS Of 202 women, 121 with a mean ( sd ) age of 67 (9.4) years contributed 221 interpretable ‘pack, then no‐pack’ UDS (111 CMGs and 110 PFS); 77 of the women had a moderate cystocele and 44 had a large cystocele. Eighty‐five women had urethral hypermobility (UH), and 36 had a well‐supported urethra (WSU). The pack unmasked stress urinary incontinence (SUI) in 6% of women, with a mean ( sd , range) Valsalva leak‐point pressure of 54 (22, 23–90) cmH 2 O. SUI occurred more often in women with UH than WSU. Detrusor overactivity occurred similarly in pack (15%) and no‐pack (14%) tracings. Bladder outlet obstruction (BOO) was relieved by the pack in 25 studies and caused by the pack in four. Women with WSU had BOO more often than those with UH (43% vs 22%, P < 0.05), regardless of the presence or absence of the pack. CONCLUSION Unmasked SUI by pack reduction was uncommon, presumably due to anterior vaginal wall stabilization, as the pack rarely caused BOO. Those with SUI had Valsalva leak‐point pressures suggestive of intrinsic sphincter deficiency. The pack did not significantly influence the presence of detrusor overactivity.