THE INCIDENCE OF LOW-PRESSURE URETHRA AS A FUNCTION OF PROLAPSE-REDUCING TECHNIQUE IN PATIENTS WITH MASSIVE PELVIC ORGAN PROLAPSE (MAXIMUM DESCENT AT ALL VAGINAL SITES)

OBJECTIVE: Our aims were to compare several prolapse-reducing techniqu es during urodynamic evaluation and prospectively evaluate their usefu lness in identifying the incidence of low urethral closure pressure in continent patients with massive prolapse. STUDY DESIGN: This preopera tive, prospective, repeated-measures urodynamic study evaluated the ma ximum urethral closure pressure with the use of four different techniq ues in 30 consecutive continent patients with grade 4 prolapse at all vaginal sites. Twenty patients with grade 0 prolapse served as the con trol group. All patients from the pro[apse group underwent surgical tr eatment and were followed up clinically for a minimum of 1 year. RESUL TS: Use of the Scopette (Birchwood Laboratories, Eden Prairie, Minn.) reduction technique to reduce the prolapse in a linear orientation dur ing multichannel urodynamics revealed a 56% incidence of tow-pressure urethra and an overall genuine stress urinary incontinence of 83% in p atients with massive pelvic organ prolapse but without clinical urinar y incontinence. CONCLUSIONS: There may be an increased indication for sling urethropexy in patients with massive prolapse.