Effect of Voiding Position on Uroflwmetry in Women with Anterior Vaginal Wall Prolapse Stage II and III

Main Article Content

Anchalee Khuntong
Rujira Wattanayingcharoenchai
Wit Viseshsindh

Abstract

Objectives: To determine the effect of voiding position on uroflowmetry parameters in women with anterior vaginal wall prolapse stage II and III


Materials and Methods:  A total of 51 women with anterior compartment prolapse stage II and III attending female pelvic medicine and reconstructive surgery clinic, Ramathibodi Hospital during June 2015 to April, 2016 were enrolled in the randomized controlled crossover study. After informed consent was obtained, participants were randomly allocated sequences of two voiding positions: sitting and modified squatting. The uroflowmetry was performed in both voiding positions for each participant. The post-void residual urine (PVR) volumes were measured using transabdominal ultrasound. Uroflowmetry parameters and PVR values were compared between the two different voiding positions.


Results: The mean age of the participants was 64.8 ± 9.1 years. The POP-Q staging was stage II in 30 (58.8%) and stage III in 21 (41.2%) women. There was no statistically significant difference in voided volume of women in sitting and modified squatting position which were 335.2 ± 160.1 and 362.7 ± 161.0 ml, respectively (p > 0.05). Mean maximum flow rate and mean average flow rate for the sitting (22.3 ± 11.2 and 10.7 ± 5.5 ml/s) and modified squatting position (23.8 ± 10.9 and 11.91 ± 6.4 ml/s) in the women were not significantly different (p > 0.05). PVR value in sitting voiding position was significant lower than in modified squatting position (52.6 ± 55.1 vs 75.0 ± 78.6) (p < 0.05).


Conclusion: Voiding positions either sitting or modified squatting does not affect urinary flow rate in women with anterior wall prolapse. Voiding in modified squatting position may results in higher post-void residual urine.


Keywords: pelvic organ prolapse, voiding position, uroflowmetry

Article Details

How to Cite
(1)
Khuntong, A.; Wattanayingcharoenchai, R.; Viseshsindh, W. Effect of Voiding Position on Uroflwmetry in Women With Anterior Vaginal Wall Prolapse Stage II and III. Thai J Obstet Gynaecol 2017, 26, 42-51.
Section
Original Article

References

1. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 1999; 180: 299-305.
2. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186: 1160-6.
3. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol 2007; 109: 848-54.
4. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 2000; 183: 277-85.
5. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001; 98: 646-51.
6. Chuenchompoonut V, Bunyavejchevin S, Wisawasukmongchol W, Taechakraichana N. Prevalence of genital prolapse in Thai menopausal women (using new standardization classification). J Med Assoc Thai 2005; 88: 1-4.
7. Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K. Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thai 2003; 86: 509-15.
8. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27: 655-84.
9. Mouritsen L. Classification and evaluation of prolapse. Best Pract Res Clin Obstet Gynaecol 2005; 19: 895-911.
10. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001; 185: 1332-7.
11. Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol 1999; 161: 581-6.
12. FitzGerald MP, Kulkarni N, Fenner D. Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol 2000; 183: 1361-4.
13. Bai S, Kang S, Kim S, Kim J, Park K. The effect of pelvic organ prolapse on lower urinary tract function. Yonsei Med J 2003; 44: 94-8.
14. Coates K, Harris R, Cundiff G, Bump R. Uroflowmetry in women with urinary incontinence and pelvic organ prolapse. Br J Urol 1997; 80: 217-21.
15. Haylen B, Law M, Frazer M, Schulz S. Urine flow rates and residual urine volumes in urogynecology patients. Int Urogynecol J Pelvic Floor Dysfunct 1999; 10: 378-83.
16. Groutz A, Gordon D, Lessing JB, Wolman I, Jaffa A, David MP. Prevalence and characteristics and voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data? Urology 1999; 54: 268-72.
17. Chae J, Park G, Kim J, Kim H, Bae J, Lee J, et al. Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele. Eur J Obstet Gynecol Reprod Biol 2014; 174: 146-9.
18. Drach GW, Laytin TV, Binard WJ. Male peak urinary flow rate: relationships to voided volume and age. J Urol 1979; 122: 210-4.
19. Axelrod SL, Blaivas JG. Bladder neck obstruction in women. J Urol 1987; 137: 497-9.
20. Haylen BT, Frazer MI. Measurement of residual urine volumes in women: Urethral catheterization or transvaginal ultrasound? Int Urogynecol J 1994; 5: 269-72.
21. Choe JH, Lee JY, Lee KS. Accuracy and precision of a new portable ultrasound scanner, the BME-150A, in residual urine volume measurement: a comparison with the BladderScan BVI 3000. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 641-4.
22. Al-Shaikh G, Larochelle A, Campbell C, Schachter J, Baker K, Pascali D. Accuracy of bladder scanning in the assessment of postvoid residual volume. J Obstet Gynaecol Can 2009; 31: 526-32.
23. Moore K, Richmond D, Sutherst J, Imrie A, Hutton J. Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition. Br J Obstet Gynaecol 1991; 98: 569-72.
24. Gupta N, Kumar A, Kumar R. Does position affect uroflowmetry parameters in women? Urol Int 2008; 80: 37-40.
25. Rane A, Corstiaans A. Does micturition improve in the squatting position? J Obstet Gynaecol 2008; 28: 317-9.
26. Yang K, Chen S, Chen S, Chang C, Wu H, Chou E. Female voiding postures and their effects on micturition. Int Urogynecol J 2010; 21: 1371-6.
27. Rane A, Iyer J. Posture and micturition: does it really matter how a woman sits on the toilet? Int Urogynecol J 2014; 25: 1015-21.
28. Fantl JA, Smith PJ, Schneider V, Hurt WG, Dunn LJ. Fluid weight uroflowmetry in women. Am J Obstet Gynecol 1983; 145: 1017-24.
29. Rad S. Impact of ethnic habits on defecographic measurements. Arch Iranian Med 2002; 5: 115-7.