Purpose: We determined whether genital prolapse causes obstruction that may
be relieved by a vaginal pessary as well as the degree to which voiding di
fficulty, urethral hypermobility, bladder outlet obstruction, occult stress
incontinence, detrusor instability and impaired detrusor contractility are
associated with prolapse.
Materials and Methods: We prospectively evaluated 60 women with a mean age
of 52 years who had genital prolapse, including 35 (58%) with grade 1 or 2
and 25 (42%) with grade 3 or 4 cystocele, using pressure-flow video urodyna
mics and cotton swab testing. Leak point pressure and uroflowmetry were rep
eated in patients with severe, prolapse after insertion of a ring pessary.
Results: Urethral hypermobility (p < 0.05) and symptoms of voiding difficul
ty (p < 0.01) were more common in women with grade 3 or 4 cystocele. Urodyn
amics revealed bladder outlet obstruction in 2 patients (4%) with grade 1 o
r 2 cystocele and 18 (58%) with grade 3 or 4 cystocele (p < 0.001). After v
aginal pessary placement bladder outlet obstruction reverted to normal free
flow in 17 women (94%) with grade 3; or 4 cystocele. Seven women (20%) wit
h grade 1 or 2 cystocele versus 13 (52%) with grade 3 or 4 cystocele had de
trusor instability (p < 0.05). Impaired detrusor contractility was noted in
each group (p > 0.05). In patients with stress incontinence intrinsic sphi
ncter deficiency did not correlate with the degree of prolapse and urethral
hypermobility did not correlate with leak point pressure.
Conclusions: Lower urinary tract symptoms are common in women with genital
prolapse. Voiding difficulty, bladder outlet obstruction and occult stress
incontinence may coexist and they are associated with prolapse. Detrusor in
stability and urethral hypermobility also correlate with the degree of prol
apse but impaired detrusor contractility and intrinsic sphincter deficiency
do not. In women with severe prolapse ring pessary reduction of prolapse d
uring urodynamics is useful to determine symptomatic and occult conditions.