EFFECTS OF SACROCOLPOSUSPENSION ON THE LOWER URINARY-TRACT

OBJECTIVE: Urinary incontinence and micturition disorders have been re ported to be common in patients who have had sacrocolposuspension proc edures for vaginal vault prolapse. From interviews with 213 patients w ho had this procedure in Birmingham from 1986 to 1992, it was found th at 53% related complaints of some urine leakage and 44% related other complaints, including frequency, urgency, and voiding dysfunction. It is also well known that frequently urinary symptoms accompany severe d efects in pelvic support. Our purpose was to determine whether sacroco lposuspension and cul-de-sac obliteration, with or without retropubic suspension and posterior colporrhaphy, had a causal relationship to lo wer urinary tract dysfunction or symptoms. STUDY DESIGN: Forty-five pa tients who had the procedures were felt to be evaluable on the basis o f preoperative documentation of a history of lower urinary tract sympt oms and an evaluation. Four to eighty months after surgery (mean 31 mo nths, median 24 months) these patients were interviewed by use of a ve rbally administered questionnaire assessing symptoms, and 24 patients underwent urodynamic testing, Preoperative and postoperative data coll ected subjectively and objectively were analyzed with Fisher's exact t est (two-tailed) or paired t test analysis. RESULTS: Lower urinary tra ct symptoms or dysfunction occurred in 87% of patients before and 49% of patients after sacrocolposuspension for vaginal vault prolapse in s pite of correction of bladder support defects. Stress urinary incontin ence was effectively treated in 92% of patients who underwent appropri ate bladder neck suspension procedures. There was no evidence that sub jective or objective voiding dysfunction, urinary frequency, urgency o r urge incontinence, or subjective and objective stress incontinence i ncreased after the above procedures. None of the seven patients who ha d no urinary symptoms preoperatively had new-onset lower urinary tract symptoms postoperatively that could be attributed to the surgery. CON CLUSIONS: (1) Lower urinary tract dysfunction is common in patients wi th significant pelvic relaxation. (2) Careful evaluation of the lower urinary tract is essential for treatment choice and to effectively cou nsel patients with total prolapse. (3) Sacrocolposuspension in itself does not significantly affect lower urinary tract function or symptoms .