Standing cystourethrogram: An outcome measure after anti-incontinence procedures and cystocele repair in women

Objectives. To evaluate the standing voiding cystourethrogram (VCUG) with l ateral views as an outcome measure to objectively document the correction o f the urethral angle and cystocele in women who underwent various types of pelvic surgery. Methods. A control group of 76 continent patients was selected who had VCUG s performed for indications other than incontinence. Patients with preopera tive and postoperative VCUGs after anterior vaginal wall suspension for ure thral hypermobility and grade 1 or 2 cystocele (UH group) or repair of grad e 3 cystocele (C group) were selected and compared with age-matched control s from the control group. Results. Among the control group, the mean +/- SD urethral angle at rest wa s 12.5 degrees +/- 13.1 degrees and the urethral angle at straining was 24. 7 degrees +/- 15.6 degrees (P <0.001). The urethral angle at rest increased significantly from women in their 20s to their 80s. In the UH group (n = 5 2), the preoperative mean urethral angle at rest and at straining was 25.7< degrees>+/- 13.6 degrees and 42.6 degrees +/- 15.9 degrees, respectively, a difference of approximately 20 degrees. The postoperative urethral angles at rest and at straining did not statistically differ from those of the age -matched controls. In the C group (n = 36), the postoperative urethral angl e at rest did not statistically differ from that of the age-matched control s. The lateral height of the cystocele demonstrated significant improvement in the UH and C groups. Conclusions. The standing VCUG is a reproducible outcome measure to preoper atively and postoperatively document the urethral angle. Using age-matched controls, a more objective definition of urethral hypermobility was obtaine d. Changes in cystocele height were observed postoperatively with a return to comparable age-matched control values. UROLOGY 58: 33-37, 2001. (C) 2001 , Elsevier Science Inc.