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Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse

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A Commentary to this article was published on 01 September 2022

Abstract

Introduction and hypothesis

Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB).

Methods

In this retrospective analysis, women with POP stage 3–4 and OAB who underwent POP repair during November 2012–December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated.

Results

One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m2 vs 25.7 kg/m2, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4–16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3–11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1–7.2]; p = 0.04) as predictive factor for persistent urgency.

Conclusions

In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.

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AP is currently board member of the International Society for the Study of Interstitial Cystitis (ESSIC)

MS is currently president of the European Urogynecological Association (EUGA)

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, Israel

    Anna Padoa, Tal Fligelman, Roni Tomashev-Dinkovich & Anna Tsviban

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Anna Padoa, Tal Fligelman, Roni Tomashev-Dinkovich & Anna Tsviban

  3. Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel

    Eyal Levy

  4. Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Eyal Levy

  5. Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy

    Maurizio Serati

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  1. Anna Padoa
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Contributions

A. Padoa: protocol development; data collection, management and analysis; manuscript writing and editing

E. Levy: protocol development; data collection, management and analysis

T. Fligelman: protocol development; data collection, management and analysis; manuscript editing

R. Tomashev-Dinkovich: data collection

A. Tsviban: data collection

M. Serati: protocol development; data management and analysis; manuscript editing

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Correspondence to Anna Padoa.

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Maurizio Serati is President of the European Urogyneclogical Association (EUGA)

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Padoa, A., Levy, E., Fligelman, T. et al. Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse. Int Urogynecol J 34, 759–767 (2023). https://doi.org/10.1007/s00192-022-05313-3

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  • DOI: https://doi.org/10.1007/s00192-022-05313-3

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