Reduction of moderate-to-large cystocele during urodynamic evaluation using a vaginal gauze pack: 8-Year experience

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: To determine the effect of cystocele reduction by a vaginal gauze pack on urodynamic studies (UDS). PATIENTS AND METHODS: UDS from consecutive women with symptomatic pelvic organ prolapse were reviewed. The protocol included a 'fill-void' study with a vaginal gauze pack, and then repeated without the pack. Tracings were categorized based on filling cystometrograms (CMGs) and pressure-flow studies (PFS). RESULTS: Of 202 women, 121 with a mean (sd) age of 67 (9.4) years contributed 221 interpretable 'pack, then no-pack' UDS (111 CMGs and 110 PFS); 77 of the women had a moderate cystocele and 44 had a large cystocele. Eighty-five women had urethral hypermobility (UH), and 36 had a well-supported urethra (WSU). The pack unmasked stress urinary incontinence (SUI) in 6% of women, with a mean (sd, range) Valsalva leak-point pressure of 54 (22, 23-90) cmH2O. SUI occurred more often in women with UH than WSU. Detrusor overactivity occurred similarly in pack (15%) and no-pack (14%) tracings. Bladder outlet obstruction (BOO) was relieved by the pack in 25 studies and caused by the pack in four. Women with WSU had BOO more often than those with UH (43% vs 22%, P < 0.05), regardless of the presence or absence of the pack. CONCLUSION: Unmasked SUI by pack reduction was uncommon, presumably due to anterior vaginal wall stabilization, as the pack rarely caused BOO. Those with SUI had Valsalva leak-point pressures suggestive of intrinsic sphincter deficiency. The pack did not significantly influence the presence of detrusor overactivity.

Original languageEnglish (US)
Pages (from-to)292-295
Number of pages4
JournalBJU International
Volume97
Issue number2
DOIs
StatePublished - Feb 2006

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Cystocele
Urodynamics
Stress Urinary Incontinence
Urinary Bladder Neck Obstruction
Urethra
Pressure
Pelvic Organ Prolapse

Keywords

  • Bladder outlet obstruction
  • Cystocele
  • Stress incontinence
  • Urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

Reduction of moderate-to-large cystocele during urodynamic evaluation using a vaginal gauze pack : 8-Year experience. / Gilleran, Jason P.; Lemack, Gary E.; Zimmern, Philippe E.

In: BJU International, Vol. 97, No. 2, 02.2006, p. 292-295.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To determine the effect of cystocele reduction by a vaginal gauze pack on urodynamic studies (UDS). PATIENTS AND METHODS: UDS from consecutive women with symptomatic pelvic organ prolapse were reviewed. The protocol included a 'fill-void' study with a vaginal gauze pack, and then repeated without the pack. Tracings were categorized based on filling cystometrograms (CMGs) and pressure-flow studies (PFS). RESULTS: Of 202 women, 121 with a mean (sd) age of 67 (9.4) years contributed 221 interpretable 'pack, then no-pack' UDS (111 CMGs and 110 PFS); 77 of the women had a moderate cystocele and 44 had a large cystocele. Eighty-five women had urethral hypermobility (UH), and 36 had a well-supported urethra (WSU). The pack unmasked stress urinary incontinence (SUI) in 6{\%} of women, with a mean (sd, range) Valsalva leak-point pressure of 54 (22, 23-90) cmH2O. SUI occurred more often in women with UH than WSU. Detrusor overactivity occurred similarly in pack (15{\%}) and no-pack (14{\%}) tracings. Bladder outlet obstruction (BOO) was relieved by the pack in 25 studies and caused by the pack in four. Women with WSU had BOO more often than those with UH (43{\%} vs 22{\%}, P < 0.05), regardless of the presence or absence of the pack. CONCLUSION: Unmasked SUI by pack reduction was uncommon, presumably due to anterior vaginal wall stabilization, as the pack rarely caused BOO. Those with SUI had Valsalva leak-point pressures suggestive of intrinsic sphincter deficiency. The pack did not significantly influence the presence of detrusor overactivity.",
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AB - OBJECTIVE: To determine the effect of cystocele reduction by a vaginal gauze pack on urodynamic studies (UDS). PATIENTS AND METHODS: UDS from consecutive women with symptomatic pelvic organ prolapse were reviewed. The protocol included a 'fill-void' study with a vaginal gauze pack, and then repeated without the pack. Tracings were categorized based on filling cystometrograms (CMGs) and pressure-flow studies (PFS). RESULTS: Of 202 women, 121 with a mean (sd) age of 67 (9.4) years contributed 221 interpretable 'pack, then no-pack' UDS (111 CMGs and 110 PFS); 77 of the women had a moderate cystocele and 44 had a large cystocele. Eighty-five women had urethral hypermobility (UH), and 36 had a well-supported urethra (WSU). The pack unmasked stress urinary incontinence (SUI) in 6% of women, with a mean (sd, range) Valsalva leak-point pressure of 54 (22, 23-90) cmH2O. SUI occurred more often in women with UH than WSU. Detrusor overactivity occurred similarly in pack (15%) and no-pack (14%) tracings. Bladder outlet obstruction (BOO) was relieved by the pack in 25 studies and caused by the pack in four. Women with WSU had BOO more often than those with UH (43% vs 22%, P < 0.05), regardless of the presence or absence of the pack. CONCLUSION: Unmasked SUI by pack reduction was uncommon, presumably due to anterior vaginal wall stabilization, as the pack rarely caused BOO. Those with SUI had Valsalva leak-point pressures suggestive of intrinsic sphincter deficiency. The pack did not significantly influence the presence of detrusor overactivity.

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