AIMS: To identify the clinical and urodynamic factors associated with the large capacity bladder and incomplete bladder emptying after prolapse repair.METHODS: We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015. Women were stratified by urodynamic capacity. The primary outcome was incomplete emptying at the longest follow-up (postvoid residual [PVR]>200mL). Data were analyzed in the Statistical Analysis System software.RESULTS: Two hundred and sixty-six women (mean age, 61 years) had preoperative urodynamic tracings available for review. After surgery, there were 519 PVRs in 239 women recorded at up to 2949 days (mean, 396) and nine time points (median, 2; IQR, 1-3). The receiver operator curve for predicted probability of longest follow-up PVR greater than 200mL (area under curve=0.67) identified the 600mL cutpoint which defined large capacity bladder. Large capacity bladders (capacity, >600mL [n=79] vs =600mL, [n=160]) had a mean: detrusor pressure at maximum flow (21 vs 22cm H2 O; P=0.717), maximum flow rate (19 vs 17mL/s; P=0.148), significantly elevated PVR (202 vs 73mL; P<0.001), and significantly lower voiding efficiency (VE) (74 vs 82%, P<0.05). Following prolapse repair, elevated PVR was associated with large capacity (PVR 101 vs 49mL, P<0.05). Large bladders had a two- to three-fold risk of longest follow-up PVR greater than 200mL (14.3%-20.3% [capacity, >600mL] vs 4.1%-7.0% [capacity, =600mL]). VE was similar after surgery regardless of the capacity (87% vs 88%, P=0.772).CONCLUSIONS: The decision to pursue prolapse repair should be individualized and take into account, the bladder capacity and goals for PVR improvement after surgery.
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