Thermodynamic Work of High-Grade Uterine Prolapse Patients Undergoing Transvaginal Mesh Repair with Total Hysterectomy.

Hui-Hsuan Lau, Cheng-Yuan Lai, Ming-Chun Hsieh, Hsien-Yu Peng, Dylan Chou, Tsung-Hsien Su, Jie-Jen Lee, Tzer-Bin Lin
Author Information
  1. Hui-Hsuan Lau: Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104217, Taiwan.
  2. Cheng-Yuan Lai: Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25245, Taiwan. ORCID
  3. Ming-Chun Hsieh: Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan.
  4. Hsien-Yu Peng: Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan.
  5. Dylan Chou: Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan.
  6. Tsung-Hsien Su: Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104217, Taiwan.
  7. Jie-Jen Lee: Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan.
  8. Tzer-Bin Lin: Institute of Translational Medicine and New Drug Development, College of Medicine, China Medical University, Taichung 404328, Taiwan. ORCID

Abstract

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure-flow and pressure-volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019-December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure-volume loop (Apv). Post-operative results showed a significant reduction in Rvod ( < 0.001, N = 15), Pvod ( = 0.021, N = 15), and Apv ( = 0.006, N = 15), along with an increase in Fvod ( = 0.003, N = 15) and a decrease in Tvod ( < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, = 0.004, r = 0.717, = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, = 0.029, N = 15) but not with ΔVvod (r = 0.353, = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder's workload.

Keywords

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Grants

  1. 109-2320-B-715-005, 108-2320-B-715-002-MY3 and 108-2314-B-715-004-MY3/Ministry of Science and Technology, Taiwan

Word Cloud

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