Significance of Bladder Trabeculation in Postmenopausal Women With Severe Pelvic Organ Prolapse

Clinical and Urodynamic Assessments

Liang, Ching-Chung MD; Chang, Yao-Lung MD; Lin, Yi-Hao MD; Chang, Shuenn-Dhy MD

Disclosures

Menopause. 2013;20(8):813-817. 

In This Article

Abstract and Introduction

Abstract

Objective: Bladder trabeculation (BT) is a secondary result of bladder outlet obstruction (BOO), which may result from severe pelvic organ prolapse (POP) and cause lower urinary tract symptoms (LUTS). This study was conducted to investigate the relationship among clinical manifestations, urodynamic findings, and BT in women with severe POP.

Methods: We reviewed the medical records of patients with stage 3 or stage 4 POP who underwent prolapse surgical operation in a tertiary hospital between 2005 and 2011. All patients received preoperative evaluations, including urodynamic studies, cystoscopy, and a structured urogynecological questionnaire. Demographics, LUTS, pelvic floor symptoms, and urodynamic findings were compared between women with BT and women without BT.

Results: Of the 308 women included, 54.9% had BT and 12.7% were diagnosed with BOO (maximal flow rate <12 mL/s; detrusor pressure at maximal flow >20 cm H2O). Mean age, prevalence of urgency, urge incontinence, voiding difficulty, detrusor overactivity, and postvoid residual greater than 100 mL were significantly higher in women with BT than in women without BT. In addition, severe BT had significantly higher prevalences of detrusor overactivity, BOO, lower maximal cystometric capacity, urge incontinence, and anterior vaginal prolapse. Logistic regression demonstrated that detrusor overactivity was the only variable associated with BT.

Conclusions: More than half of the women with severe POP have BT, which, when compared with women without BT, indicates higher incidences of LUTS, detrusor overactivity, and urinary retention. An objective evaluation of BT should become a prerequisite examination for women with severe POP who would undergo prolapse surgical operation.

Introduction

Pelvic organ prolapse (POP) is a common condition that can affect a woman’s quality of life. It has been reported that as many as 11% of women in their lifetime required a single operation for POP and stress urinary incontinence.[1] Women with POP may present with a variety of lower urinary tract symptoms (LUTS), such as urinary frequency, urgency, urinary incontinence, and various forms of voiding dysfunction.[2,3] Because of distortion of the lower urinary tract, severe POP may cause urethral obstruction, impede Valsalva maneuver voiding, and mask sphincteric urinary incontinence.[4,5,6,7] As a result, women with severe POP often experience symptoms of voiding difficulty,[8,9] reduced maximal urine flow rates,[6,10] and elevated postvoid residual (PVR).[10]

Among men, hypertrophy of bladder muscle and trabeculation can develop in response to bladder outlet resistance, particularly caused by prostatic hyperplasia.[11] Previous studies reported that the presence of bladder trabeculation (BT) on radiological examination is a useful sign for the diagnosis of bladder outlet obstruction (BOO) in men.[12]

Previous anti-incontinence surgical operation and severe POP were reported as the most common etiologies of BOO among women.[13] Several studies showed that BOO is a frequent finding in women with severe POP.[8,13,14] In addition, detrusor overactivity is reported more commonly in women with severe POP,[7,8,14] but the significance of BT in women with POP is unclear. This study was conducted to investigate the relationship among clinical manifestations, urodynamic findings, and BT in women with severe POP.

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