Interventions Used to Treat De Novo OAB After SUI Surgery: A Systematic Review

Objectives: De novo overactive bladder (OAB) is a known complication post stress urinary incontinence (SUI) surgery, including the mid-urethral sling (MUS) and Burch colposuspension. The effectiveness of treatments aimed at managing de novo OAB remains unclear. We aim to assess the efficacy of varied interventions used to treat de novo OAB after SUI surgery.

Methods: This study is a systematic review consisting of a randomized controlled trial (RCT), cohort studies, and case series. We conducted searches in MEDLINE, EMBASE, COCHRANE LIBRARY, and CINAHL. We also sought full text articles from conference proceedings. We included studies with women who had undergone primary anti-incontinence procedures within one year of treatment for de-novo OAB. Two authors independently performed study screening, risk of bias assessments, and data extraction.

Results: Ten studies (732 patients) were included. Women using solifenacin experienced less daily urgency episodes six weeks postoperatively compared to controls (RR, 0.72 [0.58-0.90]), as did both solifenacin and mirabegron compared to controls (RR 0.77 [0.64-0.93], moderate quality of evidence). A larger percentage of women who underwent urethrolysis or sling excision experienced improvement in urgency symptoms (65% [0.46-0.84]) rather than complete resolution (51% [0.42-0.60], low quality of evidence). Resolution of urgency occurred more in the urethrolysis group compared to the pharmacotherapy group, however this was not significant (RR, 1.15 [0.83-1.59], low quality of evidence).

Conclusions: At present, more studies are needed to determine which interventions are more effective at improving OAB symptoms following SUI surgery, due to very low-quality evidence and limited studies assessing these effects. Pharmacologic agents may be useful in improving de novo OAB symptoms, however, there is a trend towards urethrolysis being more effective than pharmacotherapy in treating these symptoms. More high-quality studies are required to assess interventions aimed at improving OAB symptoms following SUI surgery.