(Poster 152) Prevalence of Microhematuria in Women with Pelvic Organ Prolapse

Objectives: Microscopic hematuria is defined as the presence of ≥3 red blood cells (RBCs) per high-power field in a centrifuged urine specimen, with a negative urine culture¹. This study aims to evaluate the prevalence of microhematuria in women with pelvic organ prolapse (POP), with and without pessary use, using microscopic urinalysis (UA) obtained via clean-catch collection. Existing literature suggests a higher prevalence of microhematuria in patients with POP (20.1%), likely due to mucosal trauma and friction associated with prolapsed bladder mobility².

Methods:

Design: Retrospective case-control study

Setting: Private urogynecology practice

Participants
Three cohort groups were analyzed:
- Group 1 (n = 51): POP with pessary use
- Group 2 (n = 63): POP without pessary
- Group 3 (n = 47): Controls without POP

Interventions: Urine samples were collected using the clean-catch method. All samples had negative urine cultures. Microscopic UA results from Groups 1 and 2 were compared independently to the control group (Group 3). Statistical analysis included a student’s t-test for continuous variables and a Chi-square (χ²) test for categorical data.

Results: Group 1 included 51 participants with pelvic organ prolapse (POP) who used a pessary. Group 2 included 63 participants with POP who did not use a pessary. Group 3, the control group, comprised 47 participants without POP. Microhematuria was most prevalent in Group 1, with 47.1% of participants affected (n = 24), a statistically significant difference compared to the control group (p = 0.003), The prevalence in Group 2 was 15.9% (n = 10), which was not significantly different (p = 0.317). Group 3 had a prevalence of 8.5% (n = 4).

Conclusions: Data on microhematuria in women with POP remains limited. Prior studies suggest trauma to the uroepithelium from prolapsed bladder mucosa may contribute to hematuria². Our findings demonstrate a significantly higher rate of microhematuria in patients with POP using a pessary, and a non-significant trend in those without pessary use. Current AUA guidelines do not include POP as a risk factor when evaluating microhematuria¹. These results underscore the importance of considering POP as a potential contributing factor, with implications for more tailored evaluation protocols and reducing unnecessary invasive diagnostics.

References
1. Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl):2473-2481. doi:10.1016/j.juro.2012.09.078
2. Pillalamarri N, Nirmal N, Corton M, Rardin C. Prevalence of microscopic hematuria in women with pelvic organ prolapse. Int Urogynecol J. 2015;26(6):869-873. doi:10.1007/s00192-014-2450-6
3. Al-Shaikh G, Al-Badr A. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health. 2014;6:445-449. doi:10.2147/IJWH.S45139
4. American College of Obstetricians and Gynecologists. Asymptomatic Microhematuria in Women. Committee Opinion No. 703. Obstet Gynecol. 2017;129(6):e146–e149.