The overall broad objective of this project is to maximize the chances for a successful outcome for elderly women who undergo uro-gynecologic surgical procedures to treat either genuine stress urinary incontinence (GSI) or severe utero-vaginal prolapse. Currently, 20 to 56% of women who undergo such surgery will have either GSI or other lower urinary tract dysfunction following surgery. In this project, postoperative GSI will be considered a surgical failure and other dysfunction, such as retention or instability, a surgical complication. Stress continence with normal function post operatively will be considered a surgical success. Outcomes will be assessed at 6 weeks and 6 months after surgery. The specific surgical procedure will vary depending upon the individual subject's anatomic defect and concurrent gynecologic condition(s). However, all subjects who have a urethropexy, will have the elevation of the urethrovesical junction achieved via colposuspension. A urodynamic measurement derived from the dynamic urethral pressure profile, the bladder to urethra pressure transmission ration (PTR), will be the important variable that will be correlated both with the surgical outcome and with intraoperative monitoring techniques. PTR determinations will be part of a complete urodynamic assessment performed before and at 6 weeks and 6 months after surgery. The two specific aims of the project are as follows: 1. Confirm the mechanisms by which the surgery effects different outcomes. Postoperative PTRs will be correlated with outcome in an effort to confirm prospectively that PTRs close to 100% result in continence and normal lower urinary tract function (success), PTRs significantly <100% result in GSI (failure), and PTRs significantly >100% result in dysfunction such as retention or instability (complication). It is anticipated that these correlations will be maintained regardless of the specific surgical procedure(s) performed. 2. Evaluate three quantitative or semiquantitative intraoperative anatomic measurements and one quantitative urodynamic measurement as monitoring techniques to predict postoperative PTRs.
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