[Vaginal reconstruction for the remedy of pelvic organ prolapse: the effect, influence on urinary and sexual function and quality of life in two-years follow-up Part II - Urinary tract: function and complications].

OBJECTIVE: To evaluate the effect, risks and benefits of vaginal reconstruction surgery for pelvic organ prolapse (POP). This article (part II of the study) focuses on the urinary tract.

DESIGN: Clinical prospective non-randomized trial, two years follow-up.

SETTING: Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.

MATERIALS AND METHODS: The cohort consisted of 410 women who underwent anterior and/or posterior vaginal repair in our hospital in the period from 1. 3. 2012 to 28. 2. 2014. From among the total, 297 women received transvaginal mesh (TVM group, mostly for the higher degree of prolapse), 113 women underwent "native tissue reconstruction" - NT group. The status was evaluated preoperatively, in the early postoperative period and 2 - 6 - 12 and 24 months after the surgery.

RESULTS: The incontinence questionnaire ICSI-SF: average score preoperatively, after 12 and 24 months: NT group: 7.1 - 4.5 - 2.6. TVM group: 4.0 - 2.5 - 2.6. Low urinary tract symptoms (LUTS): preoperatively NT group 72% women, mostly combined (impaired both capture and evacuation) in 27.9%, incontinence mixed (MUI) 15.3% and stress (SUI) 9.0%. TVM group - LUTS in 74.3% women, combined difficulties (27.4%) were followed by evacuation problems (16.2%) and 6.8% resp. 3.0% MUI and SUI. Two years after: without any LUTS were 46.1% and 55.3% in the NT resp. TVM group. The most frequented symptom was incontinence (MUI - SUI - UUI in 7.9 - 5.6 - 4.5%), followed by urgency in 5.4% after TVM, whereas in the NT group prevailed UUI (urgent incontinence) 10.1%. Both SUI and combined problems had 7.9% women and MUI resp. urgency was in 4.5% each.Complications according to the International ICS/IUGA classification: T1 (0-48 hours): retention (PVR >100 ml) and/or bacteriuria in the NT group had 11 women (9.7%), in the TVM group 39 women + twice bladder perforation (altogether 13.8%). The maximum of complications was detected in the period T2 and T3 (2-6 resp. 6-12 months after surgery): in the NT group 41.7% resp. 46.0% of controls, in half of them SUI. In the TVM group the overall number of complications was 29.4% resp. 29.1%, the most often was SUI. The last period T4 (over 12 months) - LUTS detected in 37.1% of controls in the NT group, in 23.9% after TVM, in both groups predominantly incontinence (NT: UUI - SUI - MUI in 12.9% - 10.0% and 8.6%, TVM: SUI - MUI - UUI in 8.5% - 6.9% and 3.6%). Other problems were rare. Re-operation for incontinence: in the NT group 11x (10.6%), after TVM surgery 36x (12.1%), with 3 (NT) resp. 15 (TVM) cases for SUI de novo.

CONCLUSION: LUT dysfunction develops and/or progresses with the progress of prolapse. Evacuation difficulties are prevalent, often with the occult stress incontinence. Prolapse correcting restores normal miction, SUI may then occur. With the increasing age and time after surgery there is increasing number of mixed and urgent incontinence. With them, women should be counseled and the LUTS should be then lege artis solved.