Voiding Dysfunction in Patients with Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors: a retrospective study.

Objective: Determine the voiding function one year following Pelvic Reconstructive Surgery (PRS) for women with Bladder Outlet Obstruction (BOO) and advanced pelvic organ prolapse (POP). Additionally, identify potential risk factors contributing to persistent voiding dysfunction (VD) after PRS. Design: Retrospective study Setting: Tertiary Centre in Taiwan. Population: Women who underwent PRS for POP-Q stage III-IV and had urodynamic study (UDS) findings of BOO from January 2006 to January 2022. Methods: Records of 1894 women underwent PRS for advanced POP reviewed. Patients with clinically confirmed POP-Q stage III-IV and UDS findings of BOO were included. Main Outcome Measures: Primary outcome: Resumption of normal voiding function one-year post-surgery, clinically and via UDS. Failure: UDS diagnoses VD and BOO. Secondary outcomes: Identify risk factors for persistent VD one-year post-surgery. Results: Total of 431 women with POP-Q Stage III and IV, UDS of Qmax <15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have VD 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveal factors associated with post-operative VD are pre-operative maximal cystometric capacity MCC ≧500 and post void residual PVR ≧200 had significant odds ratios with 95% confidence intervals (Univariate: 3.1 [1.6-7.1], 2.1 [1.1-5.0]; Multivariate: 3.4 [1.6-8.4], 2.3 [1.5-6.5], respectively). Conclusions: VD may persist in women with BOO following PRS, particularly in those with pre-operative MCC ≥500ml and PVR volume ≥200ml.