Pressure measurement
IAP was measured by a single experienced investigator preoperatively before the pelvic organ prolapse reconstruction procedure or D&C. Before the induction of any general or spinal anesthesia, a Foley catheter was placed, as is our current standard of care.
IAP measurements were obtained with the patient in the fully supine position without head of bed elevation and at the end of expiration, according to the recommendations by the World Society of the Abdominal Compartment Syndrome (WSACS).7 The mid-axillary line at the level of the iliac crest was used as the zero reference point. The Foley catheter was clamped 2 centimeters distal to the port. The pressure transducer system was connected to the pressure monitoring cable tubing was then connected to the Foley catheter via a 16-gauge needle through the port on the catheter tubing. A 50 mL syringe was attached to the distal stopcock and filled with saline, and the stopcock was turned off toward the patient. Then, 50 cc of sterile saline was instilled into the bladder and the measurement of IAP was performed for 30-60 seconds, after pressure stabilization and the end of respiratory expiration were ensured.10 The second measurement was performed 6 months after prolapse surgery with the same protocol.