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Urodynamic investigation in women with stress urinary incontinence and cystocele

Urodynamic investigation in women with stress urinary incontinence and cystocele. Gordon Hosker. The Warrell Unit, St Mary’s Hospital, Manchester. UK. Cystocele can change the anatomical relationship between the bladder and the urethra. Green - Type I. Green – Type I. Green - Intermediate.

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Urodynamic investigation in women with stress urinary incontinence and cystocele

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  1. Urodynamic investigation in women with stress urinary incontinence and cystocele Gordon Hosker The Warrell Unit, St Mary’s Hospital, Manchester. UK.

  2. Cystocele can change the anatomical relationship between the bladder and the urethra

  3. Green - Type I

  4. Green – Type I

  5. Green - Intermediate

  6. Green - Intermediate

  7. Green – Type II

  8. Green – Type II

  9. Filling cystometry • Prolapse can mask incontinence. • During filling cystometry, if no incontinence is seen, carefully reduce the prolapse with a finger, speculum, or pessary and repeat the stress test.

  10. Voiding cystometry • Prolapse can kink the urethra. • This gives the appearance of obstructed voiding on pressure/flow studies.

  11. Normal pressure-flow

  12. Outflow obstruction

  13. Detrusor Overactivity • More prevalent in large cystocele compared to moderate cystocele • Some resolution with prolapse surgery? Romanzi et al, 1999 Golomb et al, 2006 Nguyen et al, 2001

  14. Other factors affecting anatomical relationships • Not only are anatomical relationships influenced by the size of the cystocele itself, they can be affected by: • Degree of bladder fullness • Patient position • Other prolapse (e.g. uterine prolapse)

  15. Recent review Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review Roovers and Oelke Int Urogynecol J (2007) 18 455-460

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