Overactive Bladder & Prolapse Repair: Investigating Symptom Relief & Duration

Objectives: Previous literature suggests some patients experience improvement of overactive bladder (OAB) symptoms following pelvic organ prolapse (POP) repair. Our primary objective was to determine the rate of OAB symptom resolution at three months post-operatively. Our secondary objectives were to investigate factors that impact symptom resolution and characterize the duration of symptom relief.

Methods: We performed an IRB-approved retrospective observational study of patients with OAB who underwent POP repair at our institution from January 2021 to February 2022. All patients underwent urogynecologic evaluation and pre-operative urodynamic testing. Patients were excluded if they did not report OAB symptoms, underwent re-operation, or did not return for post-operative evaluation. Demographic and clinical characteristics were collected. Summative statistics were performed using Fisher’s exact tests and Mann-Whitney U tests.

Results: One hundred and twelve patients were screened and 87 patients met inclusion criteria. Seventy-one participants (81.6%) who underwent POP repair experienced OAB symptom resolution at three months post-operatively. Pelvic surgeries included suburethral sling, anterior/posterior colporrhaphy, enterocele repair, supracervical hysterectomy, vaginal trachelectomy, levator myorrhaphy, and high uterosacral ligament fixation. No statistically significant association was found between POP surgery type and OAB symptom outcomes. Twenty-three participants used OAB medication pre-operatively and 11 patients (47.8%) discontinued medication post-operatively. Seventeen participants (23.9%) reported return of OAB symptoms, with average relapse occurring 292 days post-operatively. Six participants (8.5%) who used OAB medication pre-operatively reported return of OAB symptoms, with average relapse occurring 209 days post-operatively. We also examined risk factors associated with persistence or relapse of OAB symptoms post-operatively such as age, BMI, parity, menopause, post-void residual volume, maximum urine flow rate, detrusor overactivity, abnormal bladder capacity, stress urinary incontinence, previous POP repair, previous hysterectomy, POP staging, and OAB medication use. On review, a statistically significant association existed between OAB symptom persistence and decreased maximum urine flow rate (mean of 14.88mL/s +/- 9.32 versus 29.98mL/s +/- 27.65, p-value 0.02666) (Table 1). A statistically significant association also existed between OAB symptom relapse after post-operative resolution and elevated BMI (mean of 28.66 +/- 3.88 versus 26.27 +/- 4.31, p-value 0.02662) (Table 2).

Conclusions: Our primary outcome showed OAB symptom improvement following POP repair regardless of procedure type. Only decreased maximum urine flow rate and elevated BMI were significantly associated with persistence or relapse of OAB symptoms respectively. Approximately half of patients who required OAB medications pre-operatively discontinued them post-operatively. In addition, if patients experience OAB symptom relapse, then symptoms typically return within one year. Interestingly, pre-operative OAB medication use, while not significantly associated with either cure or relapse, may predict a shorter duration of symptom relief post-operatively. Overall, our findings may assist providers in pre-operative counseling regarding realistic post-operative outcomes, possible reduction in need for OAB medication post-operatively, and projected length of OAB symptom relief.