Changes in urodynamic measurements and bladder neck position after single-incision trans-vaginal mesh for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is common in patients with pelvic organ prolapse. This study hypothesized that SUI may be persistent, de novo, or even cured in women after Elevate™ mesh repair alone and that SUI is associated with urodynamic changes and bladder neck position.

METHODS

This secondary analysis included a study cohort of 100 women who underwent Elevate repair. All of them underwent multi-channel urodynamic measurements, 1-h pad test, and bead chain urethrocystography to measure the bladder neck position pre-operatively and at 3 months post-surgery.

RESULTS

Fifty-five women with pelvic organ prolapse were continent and 45 had concomitant SUI. Of the 55 continent women, 19 (35%) had de novo SUI after mesh repair surgery and 5 (9%) subsequently underwent anti-incontinence surgery. Of the 45 incontinent women, 11 (24%) became dry after mesh repair without additional anti-incontinence surgery. Of the remaining 34 (76%) with persistent SUI, 15 (33%) underwent subsequent anti-incontinence surgery. Patients with de novo and persistent SUI had a greater decrease in maximal urethral closure pressure (MUCP) after mesh repair (p = 0.03 and 0.01 respectively). Those cured of SUI also had decreased MUCP (p = 0.12), but the bladder neck position while straining was significantly more elevated after mesh repair (p < 0.01) compared with those with persistent SUI.

CONCLUSIONS

Elevate mesh reinforcement significantly decreases post-operative MUCP, which is associated with SUI, but can elevate the bladder neck position. Correcting a hyper-mobile urethra is associated with treatment of the concomitant SUI.