The Influence of Preoperative Urodynamics on Management in Women With Pelvic Organ Prolapse

Abstract

Importance: The role of preoperative urodynamic studies (UDS) in women undergoing pelvic organ prolapse (POP) surgery remains controversial, especially regarding their influence on surgical planning and patient counseling. Objective: To evaluate the impact of preoperative UDS on changes in surgical management and counseling among women with advanced-stage POP undergoing surgical repair. Design: Retrospective observational study. Setting: Tertiary urogynecology center at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Participants: A total of 118 women with POP-Q stage III or IV who underwent UDS before planned POP surgery between July 2018 and July 2023. Interventions: All participants underwent standardized multichannel UDS, including POP reduction during testing, based on institutional protocol and international guidelines. Main Outcomes and Measures: The primary outcome was the proportion of cases in which UDS findings led to changes in surgical or medical management. Secondary outcomes included the role of UDS in enhancing preoperative counseling and identifying discrepancies between symptoms and objective findings. Results: The mean age of participants was 69.4 years (SD 7.7), with 97.5% being postmenopausal. UDS altered clinical management in 23 cases (19.5%). Notable changes included the addition or omission of anti-incontinence procedures and initiation of OAB treatment. UDS also enhanced the preoperative counseling process, contributing to informed decision-making in 67 patients (56.8%) and excluding misleading symptoms in 69 cases (58.5%), such as absence of detrusor overactivity in OAB or detrusor underactivity in voiding dysfunction. Conclusions and Relevance: Preoperative UDS led to management changes in approximately one in five patients with advanced POP, particularly those with SUI, occult SUI, or voiding dysfunction. Although major surgical changes were infrequent, UDS provided significant value for patient counseling and risk stratification. These findings support a more selective and context-specific approach to the use of UDS in POP surgical planning.