Bladder Prolapse Configuration on Baseline Standing Cystogram Can Predict Anterior Vaginal Wall Suspension Procedure Outcomes

Abstract Objectives To evaluate whether bladder prolapse shape on lateral voiding cystourethrogram (VCUG) is an accurate predictor of anterior vaginal wall suspension (AVWS) procedure outcomes. Methods Following IRB approval, pre-operative lateral standing VCUG views from a prospectively maintained database of women who underwent AVWS for stage ≥2 cystocele were reviewed retrospectively by three reviewers. Patients with no retrievable pre-operative VCUG imaging were excluded. Only the straining view with a fixed bladder volume of 125cc was used for this project. Cystocele shape on imaging was scored as either: 1) “round,” 2) “crescent,” or 3) not readable (suboptimal image quality or excessive artifact from prosthesis). A subset of cases were re-scored by each reviewer for intra-rater reliability analysis. Intra- and inter-rater reliability were calculated using the weighted kappa coefficient (κ). Cystocele shape was correlated with the published long-term clinical outcomes after AVWS of these same women, with failure defined as prolapse recurrence stage >2 clinically or reoperation for prolapse (Kaplan-Meier). Results Between 1997 and 2013, 79 women met study criteria. All three reviewers had moderate to high intra-rater reliability (κ = 1.00, 0.82, and 0.79). Inter-rater reliability between the 3 reviewers was significant (κ = 0.76) with 81% (64/79) ratings in perfect concordance and 19% (15/79) with 1 reviewer discordance. Prolapse recurrence-free probability between “round” and “crescent” shaped cystoceles was statistically significant ( p = 0.0304). Conclusions Bladder prolapse shape on baseline standing VCUG can be used to predict AVWS outcomes with “round” shaped cystoceles faring better with this vaginal native tissue repair procedure.