Urodynamic Outcomes in Women with Pelvic Organ Prolapse Assessed using Pelvic Organ Prolapse Quantification: A Prospective Study

Background: Urodynamic studies (UDS) are diagnostic tools used to evaluate urinary function and guide the management of conditions such as detrusor overactivity (DO) and urodynamic stress incontinence (USI), both of which significantly affect the quality of life of patients. Despite their clinical importance, comprehensive data on the relationship between these outcomes and pelvic organ support are lacking. Pelvic organ prolapse (POP), commonly assessed using the standardized pelvic organ prolapse quantification (POP-Q) system, is frequently associated with lower urinary tract symptoms (LUTS). This study aimed to determine the correlation between POP-Q classification and UDS findings and to investigate the association of different types of POP with DO and USI. Methods: This prospective observational cohort study encompassed women presenting to or referred to the Urogynecology Clinic at King Saud University Medical City, Riyadh, Saudi Arabia. Consecutively enrolled women underwent comprehensive clinical evaluations, including medical history, pelvic examination using the POP-Q system, and standardized urodynamic testing. Chi-square and analysis of variance (ANOVA) tests were used to examine the correlation between anatomical findings and urodynamic parameters, including bladder capacity, post-void residual (PVR), maximum flow rate (Q-max), flow time, time to maximum flow, first desire to void, and strong desire to void. Statistical significance was defined as p < 0.05. Multiple linear regression (MLR) was used to determine the independent predictors of each UDS diagnosis. Results: Out of the 153 women included, 127 had POP, among whom 74% experienced USI. The most frequent types of POP were anterior (92.1%) and posterior (91.3 %) vaginal wall prolapses, whereas apical prolapse was less frequent (39.4%). Among those with apical prolapse, a significant correlation was observed with time to maximum flow (p = 0.050), even in the earlier stages. A significant association was observed between anterior prolapse and PVR (p = 0.026). Posterior prolapse was significantly correlated with Q-max (p = 0.014) and flow time (p = 0.046). These findings indicate that some elements obstruct the urine outflow. No significant correlations were observed between the USI or DO and the different stages of apical (p = 0.51; p = 0.60), anterior (p = 0.40; p = 0.80), or posterior prolapse (p = 0.55; p = 0.59). The presence of a history of stress incontinence was associated with a four times greater likelihood of the presence of USI in UDS. Conclusions: This study showed that different stages and types of POP were linked with certain urodynamic findings, suggesting the presence of partial urine outflow obstruction might occur. These findings indicate complex clinical interactions that require personalized management. Recognizing these associations enables clinicians to tailor individualized interventions, such as pessary use, pelvic floor physical therapy, or surgical correction, based on the affected compartment involved and the urodynamic profile, thereby improving symptom control and patient outcomes.