Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study | Actas Urológicas Españolas (English Edition)

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Estudio de cohortes multicéntrico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 2167 "Tamanyo" => 131171 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Evolution of voiding dysfunction symptoms according to the PFDI-20 questionnaire before and after surgery. PFDI: Pelvic Floor Distress Inventory Questionnaire. p<0.001." ] ] ] "textoCompleto" => "IntroductionIn a high proportion of women, advanced pelvic organ prolapse (POP) is associated with lower urinary tract symptoms (LUTS), indicating both, urinary incontinence (UI) and bladder voiding dysfunction (BVD).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The International Urogynaecological Association (IUGA) – International Continence Society (ICS) joint report highlights the importance of ruling out VD in these patients through post-void residual volume (PVR) measurement, and flowmetry, when possible.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The ICS defines VD as abnormally slow and/or incomplete micturition, based on abnormal slow urine flow rates and abnormally high PVR. The diagnosis is based on the patient's symptoms and the measurement of flowmetry and PVR, and urodynamic testing with pressure-flow study is required in order to determine the cause.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Incomplete bladder emptying implies the presence of PVR volume as an initial sign and is defined as the volume of urine (ml) left in the bladder at the completion of micturition. Although catheterization has been considered the gold standard for PVR measurement, ultrasound has also been validated, using the PVR volume per catheterization as a reference.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Although there is no universally accepted definition of a PVR volume that would indicate the presence of incomplete bladder emptying, the significant limit established in clinical practice is a PVR of 100ml. We must keep in mind that although PVR can be considered a marker for VD, it does not determine its cause.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>POP may be among the causes of VD in women.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> Currently, the diagnosis consists of a thorough study of the medical history followed by a detailed physical examination. In addition, other specific tests are recommended, such as PVR, the stress test and the study of urethral mobility assessment.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Treatment options currently available for symptomatic POP include expectant management, conservative treatment, and surgical repair, either through the vagina or abdomen.Although the association between advanced POP and VD is accepted, there is very little information regarding the impact, in women intervened for POP, on the symptoms suggestive of VD and PVR, which makes it difficult to make a prognosis of the evolution of VD associated with POP. In the context of the CIRPOP-IUE study, developed by the Research Group on Pelvic Floor Dysfunctions in Women (GISPEM, for its initials in Spanish), the impact of POP vaginal surgery on VD symptoms and PROM was analyzed.Material and methodsThe CIRPOP-IUE is an epidemiological, longitudinal, prospective cohort study, in which 39 gynecology departments specialized in pelvic floor pathology from all over Spain, belonging to the GISPEM, participated. The study protocol was approved by the ethics committee (CEIC) of the Hospital Clínic i Provincial in Barcelona. The approval record number is 2011/7037. The main objective of the study was to evaluate the frequency, type, and severity of LUTS in female POP patients who would undergo surgery and to determine the impact of surgical repair. Additionally, a subanalysis was performed to evaluate the impact of POP surgery on other urinary symptoms, including VD and PVR. Despite being a multicenter study including a high number of participating pelvic floor departments, the recruitment period had to be prologued in order to include the number of previously planned patients. A total of 345 patients were included before the extension of the recruitment period, and some of the analyses and results reported to respond to different aspects of the study objectives are based on this study population.Study populationWe consecutively included women with grade ≥2 symptomatic POP according to the POP-Q (Pelvic Organ Prolapse Quantification) classification who were to undergo surgery for vaginal prolapse and did not meet any of the exclusion criteria (Annex 1), who had previously given their informed consent. The POP-Q system allows the classification of POP into 5 stages, from 0 (no POP demonstrated) to 4 (the most distal prolapse protrudes to at least the total vaginal length TVL-2cm). Surgery would be indicated in symptomatic patients with stage ≥2 POP. The study consisted of a preoperative baseline visit and a follow-up visit 12 months after surgery. The final sample size had 360 patients at baseline visit and 319 at follow-up visit, of which 277 and 281, respectively, had the PVR result measured by bladder catheterization available.The study was carried out following the ethical principles of the Declaration of Helsinki and the rules of the International Council for Harmonization. The type of surgical procedure through vaginal route to be applied was determined by the physician, based on his clinical criteria according to the routine practice in each center.Variables collected in the studyAge, comorbidities and type of surgery, among other variables, were collected at the baseline visit. Both visits included a complete pelvic examination comprised of determination of the type and stage of POP, functional assessment of the pelvic floor muscles, standardized stress test and measurement of PVR by ultrasound and bladder catheterization.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> The PVR measured by catheter was used for the analysis. At both visits, the patients completed the EPIQ (Epidemiology of Prolapse and Incontinence Questionnaire)<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and the PFDI-20 (Pelvic Floor Dysfunction Inventory)<a class="elsevierStyleCrossRef" href="#bib0055">11</a> questionnaires, both validated in their Spanish version. Detailed information on the administration of the questionnaires is provided in Annex 2.Statistical analysisThe results of the different symptoms referred through the EPIQ and the PFDI-20 were described on the sample of 360 patients. The presence of symptoms suggestive of VD between both visits was descriptively compared according to the affirmative answers reported in the questionnaires, and the existence of differences before and after the surgery was evaluated. The correlation between symptoms of VD and incomplete emptying was studied in 345 patients, evaluated by EPIQ and PFDI-20.Patients were stratified into 3 groups according to PVR: ≥0 to <50ml; ≥50 to ≤100ml; or >100ml. Statistical analysis was performed to the variation of the PVR volume before and after surgery, as well as the percentage of patients with mean values between 50 and 100 at baseline and follow-up visits.The results were expressed as frequencies and percentages for the categorical variables and as mean and standard deviation (SD) for the continuous variables. The Kolmogorov–Smirnov test was used to evaluate the normality of the variables. The variables were analyzed with parametric or non-parametric tests depending on their distribution. The categorical results were compared using the McNemar's test and the Fisher's exact test, and the continuous variables were analyzed with the Mann–Whitney U test. The results of the questionnaires were compared using the ANOVA test or the Skillings–Mack test. The degree of correlation was analyzed using the Spearman's correlation coefficient (rho). A grade of 0.05 was considered significant. The statistical analyses were carried out with the programs SPSS (Statistical Package for the Social Sciences, version 14.0) and Stata software (version 10.0).Results<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> present the main sociodemographic and clinical variables of the patients. At the baseline visit, 182 (50.6%) of the 360 patients answered yes to item 28 of the EPIQ, a similar result to that obtained with the PFDI-20 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The correlation between responses to questions about difficulty urinating between the two questionnaires was moderate, although significant (p<0.0001) when assessing both, VD symptoms (Spearman's rho: ρ=0.36) and incomplete emptying (EPIQ) and VD (PFDI-20) (Spearman's rho: ρ=0.57).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Data were obtained on the PVR measured by catheterization before the intervention in 277 women, with a mean baseline value (SD) of 66.4 (68.9)ml. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the relationship between the PVR of the 3 patient groups and the VD symptom according to the EPIQ, which was statistically significant (p=0.003).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>All patients underwent surgical treatment for POP via the vaginal route (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). In relation to the subjective cure of POP one year after the intervention, only 40 women affirmed to have a bulge sensation, which shows a significant reduction with respect to the baseline visit (p<0.0001). A similar result was obtained from PFDI-20, with 290 women responding positively at the start of the study and only 39 in follow-up (p<0.0001), giving a subjective cure rate of 86.6% (251/290).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The results of the PFDI-20 questionnaire (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and item 28 of the EPIQ (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), after performing POP surgery in isolation (n=197) compared to combined POP and stress urinary incontinence (SUI) surgery (n=118), showed that surgical treatment for POP derived in a remarkable improvement in these patients.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of the PVR volume obtained by catheterization based on the presence or absence of VD symptoms according to EPIQ. Of the 116 women with PVR ≥50ml at the first visit, 70 (60.34%) referred VD through EPIQ item 28 at baseline and only 18 (16.7%) at the follow-up visit (p<0.001); and of 42 women with PVR>100ml at baseline, 29 (69.04%) referred VD before surgery and only 11 (24.4%) after surgery.One year after undergoing surgical treatment for POP, a statistically significant reduction in PVR volume measured by catheterization was observed. In the cohort of patients, the mean PVR volume went from 66.42 at the baseline visit (pre-surgery) to 48.33 at the follow-up visit (post-surgery). In the group of patients with PVR≥50ml, the PVR values were 122.89 and 63.15 and in the patients with PVR≥100ml, 189.27 and 85.17 at the baseline and follow-up visits, respectively, evidencing a statistically significant difference (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe present work presents the results of a subanalysis of the CIRPOP-IUE study which evaluates the presence of VD symptoms in women with grade ≥2 POP in the surgical waiting list through validated questionnaires. Based on our results, we can affirm that half of the women with POP≥2 gave an affirmative answer to the question Do you experience difficulty emptying your bladder? and also have other symptoms suggestive of VD, such as a feeling of incomplete emptying or the need to manually reduce POP in order to urinate. In our study, this symptom, which is more indicative of an obstructive type of VD associated with POP, was present in 25% of the patients, coinciding with the study by Burrows et al., who report that 21% of patients with POP≥2 require this maneuver in order to start urinating.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> According to the limited published data, the overall prevalence of VD symptoms in women with symptomatic POP≥2 is comparable to that of women with lower-grade POP. In this regard, Bradley and Nygaard<a class="elsevierStyleCrossRef" href="#bib0065">13</a> find that 43% of the women in the Women's Health Initiative (WHY) study, who present a grade 1–2 POP, report symptoms of VD. Several authors have shown that there does not seem to be a correlation between POP grade and the prevalence of VD symptoms.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a>In our cohort of women with POP≥2 and treated with vaginal surgery, we observed that VD symptoms are significantly reduced after surgical repair of POP. One year after the intervention, approximately only one in ten women reported symptoms of difficult urination and a feeling of incomplete emptying, and only 1% reported having to insert the lump into the vagina in order to urinate.In our study, 15% of the women with POP≥2 had a PVR volume >100ml before surgery; this rate is similar to the 11% reported by Lukacz et al. in their study,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> but in their case, only 50% of the population analyzed presented symptoms of POP, which would explain the lower prevalence. Wong et al.,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> in a study with similar characteristics to the latter (with and without POP), found a prevalence of 11.4% of women with PVR volume >100ml.Twelve months after the intervention, the PVR volume measured by bladder catheterization was re-evaluated and the mean PVR had significantly decreased. When analyzing the changes in the mean PVR volume in the group of patients with PVR>100ml before the intervention, it was observed that the mean residual urine volume was also significantly reduced, with a mean value lower than 50% of the preoperative volume. In a study by Fitzgerald et al. on a group of women with the same characteristics, 89% of them presented a PVR<100ml at 3 months after the intervention.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Vaginal surgery in women with grade≥2 symptomatic POP reduces both VD symptoms and mean PVR volume. These changes have been observed in women submitted to POP surgery, as well as in patients with combined surgery for POP and SUI. Our data on the decreased PRM after POP surgery (with or without SUI correction) are consistent with those of similar studies in which the PRM of all women who had a PVR>100 before surgery was reduced to less than 100ml after surgery.<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> However, an observational study by Liang et al. concludes that undergoing a concomitant anti-incontinence procedure is the only predictor of elevated post-operative PVR.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>The present work has some limitations derived from its design, beginning with the sample size, which has not been calculated exclusively for the assessment of VD, since this was not the main objective of the study. In addition, as it is a prospective study, loss to follow-up, although scarce, can limit the results. On the other hand, results have not been analyzed by age groups, which is an aspect that could affect surgery and that would constitute an interesting subject of further studies.Among the study strengths, objective data have been used for the evaluation of VD, such as the mean volume of the PVR, and validated questionnaires with good correlation between them have been used for the subjective evaluation. However, when interpreting the results, it should be borne in mind that the questionnaires detect symptoms which are not an objective reality of the patient. We must highlight that the present study also points out a relationship between the measurement of the mean PVR volume and the symptoms of VD reported in the EPIQ questionnaire, a validated tool that can be useful to the health professional in the follow-up and evolution of the patient in usual clinical practice in our country. On the other hand, and in view of the scarce information available on the evolution of VD symptoms before and after POP surgery by the vaginal route, this work provides relevant information on the evolution of these symptoms in women who have undergone POP surgery under routine clinical practice in our country. We must add that the isolated PVR does not allow determining if the cause of VD is due to obstruction or to hypocontractile or acontractile detrusor. VD does not have to be exclusively due to POP, but the prevalence of bladder hypocontractility increases with age, just as in POP. The performance of urodynamic testing in patients with high PVR volume, prior to surgery, can provide relevant information when making decisions, especially if the symptomatology leading to surgery is exclusively VD.ConclusionsIn this cohort of patients who underwent vaginal POP surgery with 1-year follow-up, an improvement in urinary dysfunction was observed, both through reduced specific symptoms of VD and a lower mean residual urine volume.FundingThis work has been funded by Astellas Pharma S.A.Conflict of interestEva María Valero Fernández is an employee of Astellas Pharma S.A." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1445115" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1318536" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1445116" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1318535" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Variables collected in the study" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack504605" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-01-21" "fechaAceptado" => "2020-03-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1318536" "palabras" => array:5 [ 0 => "Pelvic organ prolapse" 1 => "Urinary incontinence" 2 => "Surgery" 3 => "Woman" 4 => "Voiding dysfunction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1318535" "palabras" => array:5 [ 0 => "Prolapso de órganos pélvicos" 1 => "Incontinencia urinaria" 2 => "Cirugía" 3 => "Mujer" 4 => "Disfunción del vaciado vesical" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesThe present study evaluates the impact of vaginal surgery for pelvic organ prolapse (POP) on voiding dysfunction (VD) symptoms and post-void residual (PVR) one year after the intervention. Material and methodsEpidemiological, longitudinal, prospective study. Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who would undergo surgery for vaginal prolapse (CIRPOP-IUE study). Sociodemographic and clinical variables were collected before and after the intervention. At both visits, patients completed the ‘Epidemiology of Prolapse and Incontinence Questionnaire’ (EPIQ) and ‘Pelvic Floor Distress Inventory’ (PFDI-20) questionnaire. PVR volume was measured by bladder catheterization immediately after spontaneous urination. ResultsVD symptoms were present in 50% cases before the intervention. PVR was measured in 277 women of which 116 (41.87%) were >50ml and 42/277 (15.2%) were >100ml. Objective and subjective reduction in VD symptoms was observed one year after the intervention. Mean PVR volume was reduced with statistical significance, from a mean (SD) of 66.4 (68.9)ml to 48.3 (51.3)ml. The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased. ConclusionsIn general, improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosEl presente trabajo evalúa el impacto de la cirugía vaginal del prolapso de órganos pélvicos (POP) en los síntomas de disfunción de vaciado (DV) y en el residuo posmiccional (RPM) un año después de la intervención. Material y métodosEstudio epidemiológico, longitudinal y prospectivo. Un total de 39 unidades de ginecología incluyeron mujeres con POP sintomático de grado 2 o superior según la clasificación Pelvic Organ Prolapse Quantification (POP-Q) que iban a ser sometidas a cirugía del prolapso por vía vaginal (estudio CIRPOP-IUE). Se recogieron variables sociodemográficas y clínicas antes y después de la intervención. En ambas visitas, las pacientes cumplimentaron los cuestionarios Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) y Pelvic Floor Distress Inventory (PFDI-20). El RPM se midió por sondaje vesical inmediatamente después de una micción espontánea. ResultadosEl 50% de las mujeres refirieron síntomas de DV antes de la intervención. El RPM se midió en 277 mujeres de las cuales en 116 (41,87%) fue >50ml y en 42/277 (15,2%) fue >100ml. Un año tras la intervención, se observó una reducción objetiva y subjetiva de los síntomas de DV. El RPM medio se redujo de forma estadísticamente significativa, pasando de una media (DE) de 66,4 (68,9)ml a 48,3 (51,3)ml. También disminuyó el número de pacientes que reportaron dificultad de vaciado y sensación de vaciado incompleto en los cuestionarios EPIQ y PFDI-20. ConclusionesEn general, se observó una mejora de la función miccional tanto a través de la disminución de los síntomas específicos de DV como de la reducción del volumen medio del RPM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Espuña Pons M, Cassadó J, Díez Itza I, Valero Fernández EM. Residuo posmiccional y síntomas de disfunción de vaciado en mujeres con prolapso de órganos pélvicos antes y después de la cirugía vaginal. Estudio de cohortes multicéntrico. Actas Urol Esp. 2021;45:57–63." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:3 [ "apendice" => "Below are the criteria for excluding patients from the study:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Patients with a previous history of POP surgery.</li><li class="elsevierStyleListItem" id="lsti0010">•Patients with a previous history of SUI surgery.</li><li class="elsevierStyleListItem" id="lsti0015">•Patients requiring abdominal POP surgery or the placement of a vaginal mesh in a posterior compartment.</li><li class="elsevierStyleListItem" id="lsti0020">•Patients who had exclusive indication of posterior colpoplasty for the treatment of POP.</li></ul>" "titulo" => "Annex 1 Exclusion criteria" "identificador" => "sec0055" ] 1 => array:3 [ "apendice" => "Patients completed two questionnaires for the subjective evaluation of VD at baseline and follow-up visits: the EPIQ questionnaire (Epidemiology of Prolapse and Incontinence Questionnaire),<a class="elsevierStyleCrossRef" href="#bib0050">10</a> for screening pelvic floor pathology, which consists of 53 items distributed in 7 dimensions, including a VD dimension of 2 items, and the PFDI-20 (Pelvic Floor Distress Inventory),<a class="elsevierStyleCrossRef" href="#bib0055">11</a> which evaluates the impact of pelvic floor pathology on the patient's quality of life and consists of 20 items grouped into 3 dimensions (urinary incontinence, POP and anorectal dysfunction). While the complete EPIQ questionnaire was filled in at the baseline visit, only the 22 items related to the impact of pelvic floor dysfunction on patients’ lives were answered at the follow-up visit. The absence of symptom of the EPIQ question #35 “sensation of bulge in the vagina or something falling out of it” and the response to item “d” of the PFDI-20 (Do you have a bulge or something falling out that you can see or feel in the vaginal area?) were taken into account to analyze the subjective cure of POP. The questions regarding voiding function that were considered for this analysis were EPIQ 28: Do you experience difficulty for emptying your bladder? and the 3 questions on the PFDI-20: h- Do you experience difficulty emptying your bladder?; i- Do you experience a feeling of incomplete bladder emptying?; j- Do you have to push up in the vaginal area with your fingers to start or complete urination?" "titulo" => "Annex 2 Administration of the EPIQ and PFDI-20 questionnaires" "identificador" => "sec0060" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 2167 "Tamanyo" => 131171 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Evolution of voiding dysfunction symptoms according to the PFDI-20 questionnaire before and after surgery. PFDI: Pelvic Floor Distress Inventory Questionnaire. p<0.001." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1138 "Ancho" => 2167 "Tamanyo" => 86129 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Presence of voiding dysfunction symptoms, before and after surgery, according to item 28 of the EPIQ questionnaire, depending on the type of surgery. Comparison between POP surgery in isolation and combined POP and SUI surgery in the presence of voiding dysfunction symptoms. EPIQ: Epidemiology of Prolapse and Incontinence Questionnaire; SUI: stress urinary incontinence; POP: pelvic organ prolapse. POP surgery (pre-post) p=0.0033; POP+SUI surgery (pre-post) p=0.0844." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1254 "Ancho" => 2167 "Tamanyo" => 97107 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Post-void residual (PVR) obtained by bladder catheterization before and after surgery. p<0.001." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; VD: voiding dysfunction; EPIQ: Epidemiology of Prolapse and Incontinence Questionnaire; SUI: stress urinary incontinence; UUI: urge urinary incontinence; PFDI: Pelvic Floor Distress Inventory; POP: pelvic organ prolapse." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Values at baseline visit \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.8 (9.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pregnancy at any time, (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaginal delivery, (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of births, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cesarean section, (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Menopause, (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidity, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary tract infections or cystitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 (34.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 (31.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary diseases/asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VD symptom (EPIQ), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">182 (50.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VD symptoms (PFDI-20), n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Difficulty emptying \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177 (49.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Feeling of incomplete emptying \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">190 (52.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need to push the lump to start urination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 (24.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UUI symptom (EPIQ), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138 (38.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptom of SUI (EPIQ), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146 (40.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485387.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the sociodemographic and clinical characteristics of the patients at the baseline visit." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "The percentages have been calculated on the total number of patients in each grade. Grade 1: n=173. Grade 2: n=238. Grade 3: n=340. Grade 4: n=123.POP: pelvic organ prolapse." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Compartment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline visit</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Total patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 (29.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183 (53.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (51.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">334 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Middle, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 (46.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128 (37.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (38.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">321 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Posterior, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (69.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 (23.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">219 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">238 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">340 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485388.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of POP according to type and grade." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "EPIQ: Epidemiology of Prolapse and Incontinence Questionnaire; PVR: post-void residual. p=0.003." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Volume obtained by catheterization \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EPIQ voiding dysfunction</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Total n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥0 to <50ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (67.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (48.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161 (58.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥50 to ≤100ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (23.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (29.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 (26.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>100ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (21.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">137 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">277 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485386.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Relationship and results of the VPR volume obtained by catheterization based on to the presence or absence of voiding dysfunction symptoms according to EPIQ." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SUI: stress urinary incontinence; POP: pelvic organ prolapse." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgical procedure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No. of patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">POP surgery without mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">188 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">POP Surgery without mesh+SUI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">POP surgery with mesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">POP Surgery with mesh+SUI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">319 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485385.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of patients according to the type of intervention." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelvic floor symptoms and severity of pelvic organ prolapse in women seeking care for pelvic floor problems" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Espuña-Pons" 1 => "M. Fillol" 2 => "M.A. Pascual" 3 => "P. Rebollo" 4 => "A.M. Mora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejogrb.2014.03.050" "Revista" => array:6 [ "tituloSerie" => "Eur J Obstet Gynecol Reprod Biol" "fecha" => "2014" "volumen" => "177" "paginaInicial" => "141" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24784712" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint report on the terminology for female pelvic organ prolapse (POP)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.T. Haylen" 1 => "C.F. Maher" 2 => "M.D. Barber" 3 => "S. Camargo" 4 => "V. Dandolu" 5 => "A. 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Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00192-009-0976-9" "Revista" => array:6 [ "tituloSerie" => "Int Urogynecol J" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "5" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19937315" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement of post-void residual urine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.D. Asimakopoulos" 1 => "C. de Nunzio" 2 => "E. Kocjancic" 3 => "A. Tubaro" 4 => "P.F. Rosier" 5 => "E. 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Dekker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iju.12789" "Revista" => array:6 [ "tituloSerie" => "Int J Urol" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "801" "paginaFinal" => "802" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25904017" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of genital prolapse on voiding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.J. Romanzi" 1 => "D.C. Chaikin" 2 => "J.G. Blaivas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1999" "volumen" => "161" "paginaInicial" => "581" "paginaFinal" => "586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9915453" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Abrams" 1 => "C.L. Khoury" 2 => "S.A. Wein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:7 [ "edicion" => "6th ed." 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Rebollo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/uog.14678" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "2015" "volumen" => "46" "paginaInicial" => "233" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25270769" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sistemática de la exploración pélvica en la mujer con prolapso genital. Hoja de recogida de datos y su cumplimentación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Espuña Pons" 1 => "M. Fillol Crepo" 2 => "M.A. Pascual Amorós" 3 => "J. 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Original article

Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study

Residuo posmiccional y síntomas de disfunción de vaciado en mujeres con prolapso de órganos pélvicos antes y después de la cirugía vaginal. Estudio de cohortes multicéntrico

M. Espuña Ponsa,

Corresponding author

mespuna@clinic.cat

Corresponding author.

, J. Cassadób, I. Díez Itzac, E.M. Valero Fernándezd

a Unidad de Uroginecología, ICGON, Hospital Clínic de Barcelona, Barcelona, Spain

b Hospital Universitari Mutua Terrassa, Terrassa, Spain

c Hospital Universitario Donostia, San Sebastián, Spain

d Departamento Médico, Astellas Pharma S.A., Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In a high proportion of women&#44; advanced pelvic organ prolapse &#40;POP&#41; is associated with lower urinary tract symptoms &#40;LUTS&#41;&#44; indicating both&#44; urinary incontinence &#40;UI&#41; and bladder voiding dysfunction &#40;BVD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The International Urogynaecological Association &#40;IUGA&#41; &#8211; International Continence Society &#40;ICS&#41; joint report highlights the importance of ruling out VD in these patients through post-void residual volume &#40;PVR&#41; measurement&#44; and flowmetry&#44; when possible&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The ICS defines VD as abnormally slow and&#47;or incomplete micturition&#44; based on abnormal slow urine flow rates and abnormally high PVR&#46; The diagnosis is based on the patient&#39;s symptoms and the measurement of flowmetry and PVR&#44; and urodynamic testing with pressure-flow study is required in order to determine the cause&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Incomplete bladder emptying implies the presence of PVR volume as an initial sign and is defined as the volume of urine &#40;ml&#41; left in the bladder at the completion of micturition&#46; Although catheterization has been considered the gold standard for PVR measurement&#44; ultrasound has also been validated&#44; using the PVR volume per catheterization as a reference&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although there is no universally accepted definition of a PVR volume that would indicate the presence of incomplete bladder emptying&#44; the significant limit established in clinical practice is a PVR of 100<span class="elsevierStyleHsp" style=""></span>ml&#46; We must keep in mind that although PVR can be considered a marker for VD&#44; it does not determine its cause&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">POP may be among the causes of VD in women&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Currently&#44; the diagnosis consists of a thorough study of the medical history followed by a detailed physical examination&#46; In addition&#44; other specific tests are recommended&#44; such as PVR&#44; the stress test and the study of urethral mobility assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Treatment options currently available for symptomatic POP include expectant management&#44; conservative treatment&#44; and surgical repair&#44; either through the vagina or abdomen&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the association between advanced POP and VD is accepted&#44; there is very little information regarding the impact&#44; in women intervened for POP&#44; on the symptoms suggestive of VD and PVR&#44; which makes it difficult to make a prognosis of the evolution of VD associated with POP&#46; In the context of the CIRPOP-IUE study&#44; developed by the Research Group on Pelvic Floor Dysfunctions in Women &#40;GISPEM&#44; for its initials in Spanish&#41;&#44; the impact of POP vaginal surgery on VD symptoms and PROM was analyzed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The CIRPOP-IUE is an epidemiological&#44; longitudinal&#44; prospective cohort study&#44; in which 39 gynecology departments specialized in pelvic floor pathology from all over Spain&#44; belonging to the GISPEM&#44; participated&#46; The study protocol was approved by the ethics committee &#40;CEIC&#41; of the Hospital Cl&#237;nic i Provincial in Barcelona&#46; The approval record number is 2011&#47;7037&#46; The main objective of the study was to evaluate the frequency&#44; type&#44; and severity of LUTS in female POP patients who would undergo surgery and to determine the impact of surgical repair&#46; Additionally&#44; a subanalysis was performed to evaluate the impact of POP surgery on other urinary symptoms&#44; including VD and PVR&#46; Despite being a multicenter study including a high number of participating pelvic floor departments&#44; the recruitment period had to be prologued in order to include the number of previously planned patients&#46; A total of 345 patients were included before the extension of the recruitment period&#44; and some of the analyses and results reported to respond to different aspects of the study objectives are based on this study population&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">We consecutively included women with grade &#8805;2 symptomatic POP according to the POP-Q &#40;Pelvic Organ Prolapse Quantification&#41; classification who were to undergo surgery for vaginal prolapse and did not meet any of the exclusion criteria &#40;Annex 1&#41;&#44; who had previously given their informed consent&#46; The POP-Q system allows the classification of POP into 5 stages&#44; from 0 &#40;no POP demonstrated&#41; to 4 &#40;the most distal prolapse protrudes to at least the total vaginal length TVL-2<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; Surgery would be indicated in symptomatic patients with stage &#8805;2 POP&#46; The study consisted of a preoperative baseline visit and a follow-up visit 12 months after surgery&#46; The final sample size had 360 patients at baseline visit and 319 at follow-up visit&#44; of which 277 and 281&#44; respectively&#44; had the PVR result measured by bladder catheterization available&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was carried out following the ethical principles of the Declaration of Helsinki and the rules of the International Council for Harmonization&#46; The type of surgical procedure through vaginal route to be applied was determined by the physician&#44; based on his clinical criteria according to the routine practice in each center&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables collected in the study</span><p id="par0040" class="elsevierStylePara elsevierViewall">Age&#44; comorbidities and type of surgery&#44; among other variables&#44; were collected at the baseline visit&#46; Both visits included a complete pelvic examination comprised of determination of the type and stage of POP&#44; functional assessment of the pelvic floor muscles&#44; standardized stress test and measurement of PVR by ultrasound and bladder catheterization&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> The PVR measured by catheter was used for the analysis&#46; At both visits&#44; the patients completed the EPIQ &#40;Epidemiology of Prolapse and Incontinence Questionnaire&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the PFDI-20 &#40;Pelvic Floor Dysfunction Inventory&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> questionnaires&#44; both validated in their Spanish version&#46; Detailed information on the administration of the questionnaires is provided in Annex 2&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The results of the different symptoms referred through the EPIQ and the PFDI-20 were described on the sample of 360 patients&#46; The presence of symptoms suggestive of VD between both visits was descriptively compared according to the affirmative answers reported in the questionnaires&#44; and the existence of differences before and after the surgery was evaluated&#46; The correlation between symptoms of VD and incomplete emptying was studied in 345 patients&#44; evaluated by EPIQ and PFDI-20&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients were stratified into 3 groups according to PVR&#58; &#8805;0 to &#60;50<span class="elsevierStyleHsp" style=""></span>ml&#59; &#8805;50 to &#8804;100<span class="elsevierStyleHsp" style=""></span>ml&#59; or &#62;100<span class="elsevierStyleHsp" style=""></span>ml&#46; Statistical analysis was performed to the variation of the PVR volume before and after surgery&#44; as well as the percentage of patients with mean values between 50 and 100 at baseline and follow-up visits&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The results were expressed as frequencies and percentages for the categorical variables and as mean and standard deviation &#40;SD&#41; for the continuous variables&#46; The Kolmogorov&#8211;Smirnov test was used to evaluate the normality of the variables&#46; The variables were analyzed with parametric or non-parametric tests depending on their distribution&#46; The categorical results were compared using the McNemar&#39;s test and the Fisher&#39;s exact test&#44; and the continuous variables were analyzed with the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; The results of the questionnaires were compared using the ANOVA test or the Skillings&#8211;Mack test&#46; The degree of correlation was analyzed using the Spearman&#39;s correlation coefficient &#40;rho&#41;&#46; A grade of 0&#46;05 was considered significant&#46; The statistical analyses were carried out with the programs SPSS &#40;Statistical Package for the Social Sciences&#44; version 14&#46;0&#41; and Stata software &#40;version 10&#46;0&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> present the main sociodemographic and clinical variables of the patients&#46; At the baseline visit&#44; 182 &#40;50&#46;6&#37;&#41; of the 360 patients answered yes to item 28 of the EPIQ&#44; a similar result to that obtained with the PFDI-20 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The correlation between responses to questions about difficulty urinating between the two questionnaires was moderate&#44; although significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; when assessing both&#44; VD symptoms &#40;Spearman&#39;s rho&#58; <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;36&#41; and incomplete emptying &#40;EPIQ&#41; and VD &#40;PFDI-20&#41; &#40;Spearman&#39;s rho&#58; <span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Data were obtained on the PVR measured by catheterization before the intervention in 277 women&#44; with a mean baseline value &#40;SD&#41; of 66&#46;4 &#40;68&#46;9&#41;<span class="elsevierStyleHsp" style=""></span>ml&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the relationship between the PVR of the 3 patient groups and the VD symptom according to the EPIQ&#44; which was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">All patients underwent surgical treatment for POP via the vaginal route &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In relation to the subjective cure of POP one year after the intervention&#44; only 40 women affirmed to have a bulge sensation&#44; which shows a significant reduction with respect to the baseline visit &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; A similar result was obtained from PFDI-20&#44; with 290 women responding positively at the start of the study and only 39 in follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; giving a subjective cure rate of 86&#46;6&#37; &#40;251&#47;290&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The results of the PFDI-20 questionnaire &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and item 28 of the EPIQ &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; after performing POP surgery in isolation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>197&#41; compared to combined POP and stress urinary incontinence &#40;SUI&#41; surgery &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>118&#41;&#44; showed that surgical treatment for POP derived in a remarkable improvement in these patients&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of the PVR volume obtained by catheterization based on the presence or absence of VD symptoms according to EPIQ&#46; Of the 116 women with PVR &#8805;50<span class="elsevierStyleHsp" style=""></span>ml at the first visit&#44; 70 &#40;60&#46;34&#37;&#41; referred VD through EPIQ item 28 at baseline and only 18 &#40;16&#46;7&#37;&#41; at the follow-up visit &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; and of 42 women with PVR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml at baseline&#44; 29 &#40;69&#46;04&#37;&#41; referred VD before surgery and only 11 &#40;24&#46;4&#37;&#41; after surgery&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">One year after undergoing surgical treatment for POP&#44; a statistically significant reduction in PVR volume measured by catheterization was observed&#46; In the cohort of patients&#44; the mean PVR volume went from 66&#46;42 at the baseline visit &#40;pre-surgery&#41; to 48&#46;33 at the follow-up visit &#40;post-surgery&#41;&#46; In the group of patients with PVR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>ml&#44; the PVR values were 122&#46;89 and 63&#46;15 and in the patients with PVR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml&#44; 189&#46;27 and 85&#46;17 at the baseline and follow-up visits&#44; respectively&#44; evidencing a statistically significant difference &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The present work presents the results of a subanalysis of the CIRPOP-IUE study which evaluates the presence of VD symptoms in women with grade &#8805;2 POP in the surgical waiting list through validated questionnaires&#46; Based on our results&#44; we can affirm that half of the women with POP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 gave an affirmative answer to the question <span class="elsevierStyleItalic">Do you experience difficulty emptying your bladder&#63;</span> and also have other symptoms suggestive of VD&#44; such as a feeling of incomplete emptying or the need to manually reduce POP in order to urinate&#46; In our study&#44; this symptom&#44; which is more indicative of an obstructive type of VD associated with POP&#44; was present in 25&#37; of the patients&#44; coinciding with the study by Burrows et al&#46;&#44; who report that 21&#37; of patients with POP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 require this maneuver in order to start urinating&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> According to the limited published data&#44; the overall prevalence of VD symptoms in women with symptomatic POP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 is comparable to that of women with lower-grade POP&#46; In this regard&#44; Bradley and Nygaard<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> find that 43&#37; of the women in the Women&#39;s Health Initiative &#40;WHY&#41; study&#44; who present a grade 1&#8211;2 POP&#44; report symptoms of VD&#46; Several authors have shown that there does not seem to be a correlation between POP grade and the prevalence of VD symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In our cohort of women with POP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 and treated with vaginal surgery&#44; we observed that VD symptoms are significantly reduced after surgical repair of POP&#46; One year after the intervention&#44; approximately only one in ten women reported symptoms of difficult urination and a feeling of incomplete emptying&#44; and only 1&#37; reported having to insert the lump into the vagina in order to urinate&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In our study&#44; 15&#37; of the women with POP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 had a PVR volume &#62;100<span class="elsevierStyleHsp" style=""></span>ml before surgery&#59; this rate is similar to the 11&#37; reported by Lukacz et al&#46; in their study&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> but in their case&#44; only 50&#37; of the population analyzed presented symptoms of POP&#44; which would explain the lower prevalence&#46; Wong et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in a study with similar characteristics to the latter &#40;with and without POP&#41;&#44; found a prevalence of 11&#46;4&#37; of women with PVR volume &#62;100<span class="elsevierStyleHsp" style=""></span>ml&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Twelve months after the intervention&#44; the PVR volume measured by bladder catheterization was re-evaluated and the mean PVR had significantly decreased&#46; When analyzing the changes in the mean PVR volume in the group of patients with PVR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml before the intervention&#44; it was observed that the mean residual urine volume was also significantly reduced&#44; with a mean value lower than 50&#37; of the preoperative volume&#46; In a study by Fitzgerald et al&#46; on a group of women with the same characteristics&#44; 89&#37; of them presented a PVR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml at 3 months after the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Vaginal surgery in women with grade<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 symptomatic POP reduces both VD symptoms and mean PVR volume&#46; These changes have been observed in women submitted to POP surgery&#44; as well as in patients with combined surgery for POP and SUI&#46; Our data on the decreased PRM after POP surgery &#40;with or without SUI correction&#41; are consistent with those of similar studies in which the PRM of all women who had a PVR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100 before surgery was reduced to less than 100<span class="elsevierStyleHsp" style=""></span>ml after surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> However&#44; an observational study by Liang et al&#46; concludes that undergoing a concomitant anti-incontinence procedure is the only predictor of elevated post-operative PVR&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The present work has some limitations derived from its design&#44; beginning with the sample size&#44; which has not been calculated exclusively for the assessment of VD&#44; since this was not the main objective of the study&#46; In addition&#44; as it is a prospective study&#44; loss to follow-up&#44; although scarce&#44; can limit the results&#46; On the other hand&#44; results have not been analyzed by age groups&#44; which is an aspect that could affect surgery and that would constitute an interesting subject of further studies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Among the study strengths&#44; objective data have been used for the evaluation of VD&#44; such as the mean volume of the PVR&#44; and validated questionnaires with good correlation between them have been used for the subjective evaluation&#46; However&#44; when interpreting the results&#44; it should be borne in mind that the questionnaires detect symptoms which are not an objective reality of the patient&#46; We must highlight that the present study also points out a relationship between the measurement of the mean PVR volume and the symptoms of VD reported in the EPIQ questionnaire&#44; a validated tool that can be useful to the health professional in the follow-up and evolution of the patient in usual clinical practice in our country&#46; On the other hand&#44; and in view of the scarce information available on the evolution of VD symptoms before and after POP surgery by the vaginal route&#44; this work provides relevant information on the evolution of these symptoms in women who have undergone POP surgery under routine clinical practice in our country&#46; We must add that the isolated PVR does not allow determining if the cause of VD is due to obstruction or to hypocontractile or acontractile detrusor&#46; VD does not have to be exclusively due to POP&#44; but the prevalence of bladder hypocontractility increases with age&#44; just as in POP&#46; The performance of urodynamic testing in patients with high PVR volume&#44; prior to surgery&#44; can provide relevant information when making decisions&#44; especially if the symptomatology leading to surgery is exclusively VD&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">In this cohort of patients who underwent vaginal POP surgery with 1-year follow-up&#44; an improvement in urinary dysfunction was observed&#44; both through reduced specific symptoms of VD and a lower mean residual urine volume&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This work has been funded by <span class="elsevierStyleGrantSponsor" id="gs0000">Astellas Pharma S&#46;A&#46;</span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">Eva Mar&#237;a Valero Fern&#225;ndez is an employee of Astellas Pharma S&#46;A&#46;</p></span></span>"
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    "fechaRecibido" => "2019-01-21"
    "fechaAceptado" => "2020-03-22"
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          "clase" => "keyword"
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            0 => "Pelvic organ prolapse"
            1 => "Urinary incontinence"
            2 => "Surgery"
            3 => "Woman"
            4 => "Voiding dysfunction"
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          "titulo" => "Palabras clave"
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          "palabras" => array:5 [
            0 => "Prolapso de &#243;rganos p&#233;lvicos"
            1 => "Incontinencia urinaria"
            2 => "Cirug&#237;a"
            3 => "Mujer"
            4 => "Disfunci&#243;n del vaciado vesical"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The present study evaluates the impact of vaginal surgery for pelvic organ prolapse &#40;POP&#41; on voiding dysfunction &#40;VD&#41; symptoms and post-void residual &#40;PVR&#41; one year after the intervention&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Epidemiological&#44; longitudinal&#44; prospective study&#46; Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification &#40;POP-Q&#41; system&#44; who would undergo surgery for vaginal prolapse &#40;CIRPOP-IUE study&#41;&#46; Sociodemographic and clinical variables were collected before and after the intervention&#46; At both visits&#44; patients completed the &#8216;Epidemiology of Prolapse and Incontinence Questionnaire&#8217; &#40;EPIQ&#41; and &#8216;Pelvic Floor Distress Inventory&#8217; &#40;PFDI-20&#41; questionnaire&#46; PVR volume was measured by bladder catheterization immediately after spontaneous urination&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">VD symptoms were present in 50&#37; cases before the intervention&#46; PVR was measured in 277 women of which 116 &#40;41&#46;87&#37;&#41; were &#62;50<span class="elsevierStyleHsp" style=""></span>ml and 42&#47;277 &#40;15&#46;2&#37;&#41; were &#62;100<span class="elsevierStyleHsp" style=""></span>ml&#46; Objective and subjective reduction in VD symptoms was observed one year after the intervention&#46; Mean PVR volume was reduced with statistical significance&#44; from a mean &#40;SD&#41; of 66&#46;4 &#40;68&#46;9&#41;<span class="elsevierStyleHsp" style=""></span>ml to 48&#46;3 &#40;51&#46;3&#41;<span class="elsevierStyleHsp" style=""></span>ml&#46; The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">In general&#44; improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Objectives"
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            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">El presente trabajo eval&#250;a el impacto de la cirug&#237;a vaginal del prolapso de &#243;rganos p&#233;lvicos &#40;POP&#41; en los s&#237;ntomas de disfunci&#243;n de vaciado &#40;DV&#41; y en el residuo posmiccional &#40;RPM&#41; un a&#241;o despu&#233;s de la intervenci&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Estudio epidemiol&#243;gico&#44; longitudinal y prospectivo&#46; Un total de 39 unidades de ginecolog&#237;a incluyeron mujeres con POP sintom&#225;tico de grado 2 o superior seg&#250;n la clasificaci&#243;n <span class="elsevierStyleItalic">Pelvic Organ Prolapse Quantification</span> &#40;POP-Q&#41; que iban a ser sometidas a cirug&#237;a del prolapso por v&#237;a vaginal &#40;estudio CIRPOP-IUE&#41;&#46; Se recogieron variables sociodemogr&#225;ficas y cl&#237;nicas antes y despu&#233;s de la intervenci&#243;n&#46; En ambas visitas&#44; las pacientes cumplimentaron los cuestionarios <span class="elsevierStyleItalic">Epidemiology of Prolapse and Incontinence Questionnaire</span> &#40;EPIQ&#41; y <span class="elsevierStyleItalic">Pelvic Floor Distress Inventory</span> &#40;PFDI-20&#41;&#46; El RPM se midi&#243; por sondaje vesical inmediatamente despu&#233;s de una micci&#243;n espont&#225;nea&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">El 50&#37; de las mujeres refirieron s&#237;ntomas de DV antes de la intervenci&#243;n&#46; El RPM se midi&#243; en 277 mujeres de las cuales en 116 &#40;41&#44;87&#37;&#41; fue &#62;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>ml y en 42&#47;277 &#40;15&#44;2&#37;&#41; fue &#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml&#46; Un a&#241;o tras la intervenci&#243;n&#44; se observ&#243; una reducci&#243;n objetiva y subjetiva de los s&#237;ntomas de DV&#46; El RPM medio se redujo de forma estad&#237;sticamente significativa&#44; pasando de una media &#40;DE&#41; de 66&#44;4 &#40;68&#44;9&#41;<span class="elsevierStyleHsp" style=""></span>ml a 48&#44;3 &#40;51&#44;3&#41;<span class="elsevierStyleHsp" style=""></span>ml&#46; Tambi&#233;n disminuy&#243; el n&#250;mero de pacientes que reportaron dificultad de vaciado y sensaci&#243;n de vaciado incompleto en los cuestionarios EPIQ y PFDI-20&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">En general&#44; se observ&#243; una mejora de la funci&#243;n miccional tanto a trav&#233;s de la disminuci&#243;n de los s&#237;ntomas espec&#237;ficos de DV como de la reducci&#243;n del volumen medio del RPM&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Espu&#241;a Pons M&#44; Cassad&#243; J&#44; D&#237;ez Itza I&#44; Valero Fern&#225;ndez EM&#46; Residuo posmiccional y s&#237;ntomas de disfunci&#243;n de vaciado en mujeres con prolapso de &#243;rganos p&#233;lvicos antes y despu&#233;s de la cirug&#237;a vaginal&#46; Estudio de cohortes multic&#233;ntrico&#46; Actas Urol Esp&#46; 2021&#59;45&#58;57&#8211;63&#46;</p>"
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            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall">Below are the criteria for excluding patients from the study&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Patients with a previous history of POP surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Patients with a previous history of SUI surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Patients requiring abdominal POP surgery or the placement of a vaginal mesh in a posterior compartment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Patients who had exclusive indication of posterior colpoplasty for the treatment of POP&#46;</p></li></ul></p>"
            "titulo" => "Annex 1 Exclusion criteria"
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            "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Patients completed two questionnaires for the subjective evaluation of VD at baseline and follow-up visits&#58; the EPIQ questionnaire &#40;Epidemiology of Prolapse and Incontinence Questionnaire&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> for screening pelvic floor pathology&#44; which consists of 53 items distributed in 7 dimensions&#44; including a VD dimension of 2 items&#44; and the PFDI-20 &#40;Pelvic Floor Distress Inventory&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which evaluates the impact of pelvic floor pathology on the patient&#39;s quality of life and consists of 20 items grouped into 3 dimensions &#40;urinary incontinence&#44; POP and anorectal dysfunction&#41;&#46; While the complete EPIQ questionnaire was filled in at the baseline visit&#44; only the 22 items related to the impact of pelvic floor dysfunction on patients&#8217; lives were answered at the follow-up visit&#46; The absence of symptom of the EPIQ question &#35;35 &#8220;<span class="elsevierStyleItalic">sensation of bulge in the vagina or something falling out of it&#8221;</span> and the response to item &#8220;d&#8221; of the PFDI-20 &#40;<span class="elsevierStyleItalic">Do you have a bulge or something falling out that you can see or feel in the vaginal area&#63;&#41;</span> were taken into account to analyze the subjective cure of POP&#46; The questions regarding voiding function that were considered for this analysis were EPIQ 28&#58; <span class="elsevierStyleItalic">Do you experience difficulty for emptying your bladder&#63;</span> and the 3 questions on the PFDI-20&#58; h- <span class="elsevierStyleItalic">Do you experience difficulty emptying your bladder&#63;&#59; i- Do you experience a feeling of incomplete bladder emptying&#63;&#59; j- Do you have to push up in the vaginal area with your fingers to start or complete urination&#63;</span></p>"
            "titulo" => "Annex 2 Administration of the EPIQ and PFDI-20 questionnaires"
            "identificador" => "sec0060"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of voiding dysfunction symptoms according to the PFDI-20 questionnaire before and after surgery&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PFDI&#58; Pelvic Floor Distress Inventory Questionnaire&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presence of voiding dysfunction symptoms&#44; before and after surgery&#44; according to item 28 of the EPIQ questionnaire&#44; depending on the type of surgery&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparison between POP surgery in isolation and combined POP and SUI surgery in the presence of voiding dysfunction symptoms&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">EPIQ&#58; Epidemiology of Prolapse and Incontinence Questionnaire&#59; SUI&#58; stress urinary incontinence&#59; POP&#58; pelvic organ prolapse&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">POP surgery &#40;pre-post&#41; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0033&#59; POP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SUI surgery &#40;pre-post&#41; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0844&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Post-void residual &#40;PVR&#41; obtained by bladder catheterization before and after surgery&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; VD&#58; voiding dysfunction&#59; EPIQ&#58; Epidemiology of Prolapse and Incontinence Questionnaire&#59; SUI&#58; stress urinary incontinence&#59; UUI&#58; urge urinary incontinence&#59; PFDI&#58; Pelvic Floor Distress Inventory&#59; POP&#58; pelvic organ prolapse&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Values at baseline visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;8 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pregnancy at any time&#44; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vaginal delivery&#44; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Number of births&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cesarean section&#44; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Menopause&#44; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinary tract infections or cystitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;34&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;31&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pulmonary diseases&#47;asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurological diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">VD symptom &#40;EPIQ&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182 &#40;50&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">VD symptoms &#40;PFDI-20&#41;&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Difficulty emptying&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177 &#40;49&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feeling of incomplete emptying&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190 &#40;52&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Need to push the lump to start urination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;24&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">UUI symptom &#40;EPIQ&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;38&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Symptom of SUI &#40;EPIQ&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The percentages have been calculated on the total number of patients in each grade&#46; Grade 1&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>173&#46; Grade 2&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>238&#46; Grade 3&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>340&#46; Grade 4&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>123&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">POP&#58; pelvic organ prolapse&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Compartment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline visit</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anterior&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;29&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">183 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;51&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128 &#40;37&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;38&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">321&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posterior&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;69&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;23&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2485388.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Classification of POP according to type and grade&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">EPIQ&#58; Epidemiology of Prolapse and Incontinence Questionnaire&#59; PVR&#58; post-void residual&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Volume obtained by catheterization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EPIQ voiding dysfunction</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;0 to &#60;50<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;67&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;48&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">161 &#40;58&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;50 to &#8804;100<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">33 &#40;23&#46;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">41 &#40;29&#46;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">74 &#40;26&#46;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;100<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">13 &#40;9&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">29 &#40;21&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">42 &#40;15&#46;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">277 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Relationship and results of the VPR volume obtained by catheterization based on to the presence or absence of voiding dysfunction symptoms according to EPIQ&#46;</p>"
        ]
      ]
      6 => array:8 [
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        "etiqueta" => "Table 4"
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        "detalles" => array:1 [
          0 => array:3 [
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            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">SUI&#58; stress urinary incontinence&#59; POP&#58; pelvic organ prolapse&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">188&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">POP surgery with mesh&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">319&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
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