77 Advanced stages of prolapse are predictive of elevated post void residual

The purpose of this study is to determine the relationship between an elevated post void residual urine volume (PVR) and stage of prolapse, as well as the relationship between specific measurements of the POP-Q exam. We performed a retrospective chart review of all women referred to a urogynecologic practice over 24 months. Stage of prolapse was determined by POP-Q exam. Post void residual (PVR) was measured by straight catheterization. Demographic data, stage of prolapse, PVR and significant co-morbid medical conditions were also collected. An elevated PVR was defined as an initial PVR >200 ml. Of the 489 women seen for prolapse over the study period that met inclusion criteria, 27 patients had stage 0 (5.5%), 98 had stage 1 (20.1%), 213 had stage 2 (43.6%), 136 had stage 3 (27.9%), and 14 were diagnosed with stage 4 (2.9%). Overall, 41 out of the 489 subjects (8.4%) were classified as having an elevated PVR. For stage 1, the prevalence of having an elevated PVR was 4.1%, for stage 2, 6.6%, for stage 3, it was 15.4%, and stage 4, 14.3%. After controlling for age, obesity, and diabetes, there was a significant association between stage of prolapse and elevated PVR status (P = 0.007). Specifically, subjects with stages 0, 1, and 2 had a significantly lower rate of elevated PVR compared to those in stages 3 or 4. As compared to those with stage 3 or 4 prolapse, the odds of an elevated PVR in stage 0 or 1 patients was lower (adjusted OR = 0.21, 95% CI = 0.07 to 0.63, P = 0.006). Similarly, those with stage 2 prolapse also had lower odds of an elevated PVR than the odds of an elevated PVR in stage 3 or 4 patients (adjusted OR = 0.44, 95% CI = 0.21 to 0.90, P = 0.025). After controlling for age, obesity, and diabetes, Ba was significantly associated with elevated PVR (adjusted OR = 1.26, 95% CI = 1.12, 1.43, P = < 0.001). For every 1 cm increase in Ba, the odds of an elevated PVR increased by 26%. In addition, Point C was also significantly associated with an elevated PVR (adjusted OR = 1.13, 95% CI = 1.05, 1.20, P = < 0.001). For every 1 cm increase in C, the odds of an elevated PVR increased by 13%. Only 22 patients out of 489 had a PVR greater than or equal to 300, 4.5%. The prevalence of a PVR > 200 ml in women presenting with pelvic organ prolapse was 8.4%. Having a PVR > 300 ml was uncommon in our cohort. This was observed more frequently in women with either Ba or C > 0. We were unable to identify other risk factors for elevated PVR based upon age, or diabetes. Advanced stages of prolapse were associated with an elevated PVR. Our study suggests that it may be clinically important for gynecologists and urogynecologists to measure PVR in women who present with stage 3 or 4 prolapse on their initial presentation.