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The Effect of Anterior Vaginal Wall Prolapse on Urethral Pressure Profile

Department of Obstetrics and Gynecology, School of Physical Therapy, and Department of Public Health, Chung Shan Medical University and Hospital, Taichung, Taiwan; Urodynamic Unit, Department of Obstetrics and Gynecology, Chung Shan Medical University and Hospital, Hospital 110, Section 1, Chien Kuo N. Road, Taichung, Taiwan 40201; gdchen{at}hotmail.com

YiChing Chen, MS

Hong-Shen Lee, PhD

Long-Yau Lin, MD, DSc

Department of Obstetrics and Gynecology, School of Physical Therapy, and Department of Public Health, Chung Shan Medical University and Hospital, Taichung, Taiwan

Objective: To evaluate whether anterior vaginal wall prolapse will cause a decrease in urethral pressure.

Methods: Two hundred ninety-four patients with uterovaginal prolapse served as study cases. In addition, 127 patients without uterovaginal prolapse were included as controls. The urethral pressure profile measurement was performed using a microtransducer and the fluid-bridge method with the patient in the lithotomy position. The parameters of the urethral pressure profile and its associated variables were compared between the control and study groups.

Results: The proximal portion of urethral pressure and the resting and stress urethral closure pressures in women with anterior vaginal wall prolapse were significantly lower than those of the control group. An indention segment (or a plateau pressure zone) in the proximal portion of the urethral pressure profile curve was noted in patients with anterior vaginal wall prolapse, especially for stage I (64.2%) and stage II (73.0%). Anterior vaginal wall prolapse and genuine stress incontinence had a statistically significant odds ratio for predicting the presence of an indentation segment (or a plateau pressure zone) in the proximal portion of the unrethral pressure profile curve (1.58 and 3.19, respectively).

Conclusions: An indention segment (or a plateau pressure zone) of the proximal portion of the wrethral pressure profile curve was observed in most of our patients with anterior vaginal wall prolapse. Defects in the anterior vaginal wall supports may attenuate the proximal urethral support, and these defects will contribute to a reduction in the proximal urethyral pressure.

Key Words: Anterior vaginal wall prolapse • proximal urethra • urethral pressure profile • uterovaginal prolapse

Journal of the Society for Gynecologic Investigation, Vol. 10, No. 5, 309-313 (2003)
DOI: 10.1016/S1071-55760300088-1


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