Bladder Prolapse Configuration on Baseline Standing Cystogram Can Predict Anterior Vaginal Wall Suspension Procedure Outcomes

Objective To evaluate whether bladder prolapse shape on lateral voiding cystourethrogram (VCUG) is an accurate predictor of anterior vaginal wall suspension (AVWS) procedure outcomes. Methods Following an institutional review board approval, preoperative lateral standing VCUG views from a prospectively maintained database of women who underwent AVWS for stage ≥2 cystocele were reviewed retrospectively by 3 reviewers. Patients with no retrievable preoperative VCUG imaging were excluded. Only the straining view with a fixed bladder volume of 125 cc was used for this project. Cystocele shape on imaging was scored as either (1) “round,” (2) “crescent,” or (3) not readable (suboptimal image quality or excessive artifact from prosthesis). A subset of cases was rescored by each reviewer for intra-rater reliability analysis. Intra- and inter-rater reliability was calculated using the weighted kappa coefficient (κ). Cystocele shape was correlated with the published long-term clinical outcomes after AVWS of these same women, with failure defined as prolapse recurrence stage >2 clinically or reoperation for prolapse (Kaplan-Meier). Results Between 1997 and 2013, 79 women met the study criteria. All 3 reviewers had moderate to high intra-rater reliability (κ = 1.00, 0.82, and 0.79). Inter-rater reliability among the 3 reviewers was significant (κ = 0.76), with 81% (64 out of 79) ratings in perfect concordance and 19% (15 out of 79) with 1 reviewer discordance. Prolapse recurrence-free probability between round- and crescent-shaped cystoceles was statistically significant (P = .0304). Conclusion Bladder prolapse shape on baseline standing VCUG can be used to predict AVWS outcomes, with round-shaped cystoceles faring better with this vaginal native tissue repair procedure.