Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse

OBJECTIVE: This study was undertaken to determine whether surgery for advan ced pelvic organ prolapse corrects the voiding dysfunction commonly associa ted with this condition and if so to evaluate the ability of preoperative v oiding studies to predict such correction. STUDY DESIGN: We reviewed the records of all women who underwent surgery at our center between January 1996 and June 1999 for stage 3 or 4 pelvic orga n prolapse. Patients were included in this review ii they had a postvoid re sidual volume of > 100 mt documented by catheterization on at least 2 occas ions, had no normal postvoid residual volumes documented, and had undergone preoperative multichannel urodynamic testing that included an instrumented voiding study. Demographic and urodynamic data were analyzed for the abili ty to predict whether the elevated postvoid residual volume would be resolv ed after surgery. RESULTS: Thirty-five patients satisfied the criteria for inclusion in the r eview. Twenty-six had stage 3 pelvic organ prolapse and 9 had stage 4 pelvi c organ prolapse. The mean preoperative postvoid residual volume was 226 mt (range, 105-600 mt). Thirty-one patients (89%) had normal postvoid residua l volumes after surgery. As a predictor of elevated postoperative postvoid residual volumes, the preoperative voiding study (performed with the prolap se reduced) had a sensitivity of 66%, a specificity of 46%, a positive pred ictive value of 12%, and a negative predictive value of 93%. CONCLUSION: In our center a preoperative voiding study performed with the p elvic organ prolapse reduced most accurately predicted postoperative voidin g function when results of the Voiding study were normal. Most patients wit h advanced pelvic organ prolapse and elevated postvoid residual volume had normalization of the postvoid residual Volume after surgical correction of the pelvic organ prolapse.