Transcript Urodynamic investigation in women with stress urinary incontinence and cystocele Gordon Hosker

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
Green - Intermediate
Green – Type II
Green – Type II
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.
Voiding cystometry

Prolapse can kink the urethra.

This gives the appearance of obstructed
voiding on pressure/flow studies.
Normal pressure-flow
Outflow obstruction
Detrusor Overactivity

More prevalent in large cystocele compared
to moderate cystocele
Romanzi et al, 1999
Golomb et al, 2006

Some resolution with prolapse surgery?
Nguyen et al, 2001
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)
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