UROFLOWMETRY IN WOMEN WITH URINARY-INCONTINENCE AND PELVIC ORGAN PROLAPSE

Objective To characterize uroflowmetry parameters in women with pelvic organ prolapse (POP) and urinary incontinence (UI) and to assess the effects of clinical and urodynamic variables on these parameters. Pati ents and methods The study comprised 655 consecutive women who present ed with UI or POP and who had interpretable uroflowmetry values, Norma l uroflowmetry values were defined as a maximum flow (Q(max)) greater than or equal to 15 mL/s, a mean flow (Q(mean)) greater than or equal to 10 mL/s, a post-void residual volume (PVR) less than or equal to 10 0 mL and a continuous, single-peak waveform, Parametric and non-parame tric analysis of variance and chi-square analysis were used to compare differences between diagnostic groups, Multiple linear regression mod els were developed to evaluate factors considered to influence uroflow metry, Results Of the 655 patients, 471 (72%) had UI of whom 16% had p ure detrusor instability (DI), 69% pure genuine stress incontinence (G ST) and 15% with both, and 184 (28%) had POP, 26% of whom also had DI. Of all patients, 72% had normal uroflowmetry patterns, 13% had multip le peaks and 15% had patterns with interrupted now; 56% had completely normal uroflowmetry. There were significant differences in uroflowmet ry values between the POP and UI groups, with the former having a lowe r Q(max) and Q(mean) (P<0.001), larger PVRs (P<0.001) and a lower perc entage of totally normal uroflowmetry (33% and 64%, respectively, P<0. 001). Of patients with POP, 30% had a PVR >100 mt. Because of the diff erences, the POP and UI groups were evaluated separately in the regres sion analysis. In both groups, the most important determinants of now rate were the volume voided and pressure transmission ratio (PTR). How ever, when several factors (including age, voided volume, PTR and maxi mum detrusor pressure with now and at Q(max)) were included in the mod el, they accounted for only 23-26% of the variability of now in the pa tients with UI and 36-39% of the variability in patients with POP. The subsets of patients with pure DI in both the UI and POP groups had hi gher PVR volumes than the other subsets, Conclusions These results sho w that the positive correlation between now rate and voided volume des cribed in normal populations is also observed in women with UT and POP . However, most of the variability in urine now was not attributable t o factors such as age, voided volume and PTR, confirming the complexit y of the micturition mechanism. Women with POP had more objective evid ence of emptying-phase dysfunction than women with UI, although most e mptied their bladders efficiently, Finally, the results suggest that w omen with DI exhibit dysfunction of both inhibitory and facilitory det rusor control.