URINARY INCONTINENCE SYMPTOMS IN WOMEN WITH ANTERIOR PROLAPSE: DOES THE ASSOCIATED APICAL PROLAPSE MATTER?
MAGALHAES 1, L. S. BEZERRA2, K. L. AUGUSTO 3, S. A. KARBAGE 4, A. P. BILHAR 5, C. VASCONCELOS 6, J. VASCONCELOS NETO 7, A. V. BRILHANTE 8, S. V. LUCENA 9;
1Univ.e Federal do Ceara, Fortaleza, Brazil, 2Saúde Materno Infantil, Federal Univ. of Ceara, Fortaleza, Brazil, 3Laparoscopy and Minimally invasive surgery, Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil, 4Univ.e Federal do Cearÿ, Fortaleza - Ceara, Brazil, 5UNIFESP, Fortaleza, Brazil, 6Univ.e Federal do Ceará, Fortaleza, Brazil, 7Hosp. Geral de Fortaleza, Fortaleza, Brazil, 8Univ.e de Fortaleza, Fortaleza, Brazil, 9SURGERY, Federal Univ. of Ceara, Fortaleza, Brazil.
Introduction: Pelvic organ prolapse (POP) is part of the pelvic floor dysfunction group, as is stress urinary incontinence (SUI). Such dysfunctions are related because they have pathophysiological factors in common. Previous studies have analyzed the relationship between urinary symptoms and anterior vaginal wall POP. Several colleagues have reported that women with advanced POP present less SUI. Other has shown that there has been improvement in both the symptoms related to SUI and Urgency /detrusor overactivity in the postoperative period. Similarly, Cetinkaya et al showed a direct association between the stage of POP and the severity of symptoms of the lower urinary tract Nevertheless, a few studies correlate the degree of anterior vaginal wall POP with urinary symptoms and quality of life (QoL).
Objective: to analyze the correlation between the Ba point and C point, measured through the POP-Q, and validated questionnaires for evaluation of lower urinary tract dysfunctions and QoL of the patients affected.
Methods: We included women in a Urogynecology outpatient clinic, who did not present with gynecological cancer, collagen diseases or cognitive deficits. A total of 613 women were evaluated, 253 who had with posterior vaginal wall POP (defined as Point Bp≥-1) were excluded. The sample (n = 360) anterior and apical POP larger than the posterior wall prolapse (C point or Ba point > Bp point) was then divided into 4 groups: Apical POP (C point ≥-1) plus anterior POP (Ba point ≥-1), n = 21; only Apical POP (C point ≥-1 and Ba point < -1), n = 3; only Anterior POP (Ba point ≥-1 and C point < -1), n = 161; Control group, n = 177. The groups were then compared for the presence of urinary symptoms, by International Consultation on Incontinence Questionnaire (ICIQ); questionnaires for the evaluation of general quality of life (Short Form 36, SF-36) and specific (Kings Health Questionnaire, KHQ). The Kruskal-Wallis and chi-square tests were used for numerical and categorical variables, respectively. Differences between the groups regarding the continuous data were assessed using either Student’s t-test (for normally distributed data) or the Mann-Whitney U test (for non-parametric data). Ethics Committee of the two Hospitals previously approved the clinical protocol, and all patients signed the consent form.
Results: There were no significant differences in QOL between the groups measured by SF-36. Patients with Apical plus Anterior POPs had a lower score in the gravity domain, as measured by KHQ, than those with only Anterior POP and Controls (p <0.05). The Apical plus Anterior POPs group also showed a lower ICIQ score and lower number of diurnal micturition than the only Anterior POP and control groups (p <0.05).
Conclusions: This is the first study comparing such groups, and shows that women with Apical plus Anterior POPs have fewer incontinence symptoms investigated, although POP-Q showed higher POP measures by point Ba and point C. Such findings may help us better understand the distinct expressions of SUI symptoms manifested in women with anterior POPs, according to the different POP-Q presentations.
References: CETINKAYA, S. E.; DOKMECI, F.; DAI, O. Correlation of pelvic organ prolapse staging with lower urinary tract symptoms, sexual dysfunction, and quality of life. Int Urogynecol J, v. 24, n. 10, p. 1645-50, Oct 2013.DIGESU, G. A. et al. The relationship of vaginal prolapse severity to symptoms and quality of life. Bjog, v. 112, n. 7, p. 971-6, Jul 2005