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Current Urology Reports

, 19:74 | Cite as

Management of Postoperative Lower Urinary Tract Symptoms (LUTS) After Pelvic Organ Prolapse (POP) Repair

  • Annie Chen
  • Brian McIntyre
  • Elise J. B. De
Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • 184 Downloads
Part of the following topical collections:
  1. Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Abstract

Purpose of Review

Pelvic organ prolapse (POP) is a common condition for which approximately 200,000 US women annually undergo surgical repair [Am J Obstet Gynecol 188:108–115, 2003]. After surgical correction, persistent or new lower urinary tract symptoms (LUTS) can be present. We provide guidance on the current tools to predict, counsel, and subsequently handle postoperative LUTS. The current literature is reviewed regarding LUTS diagnosis and management in the setting of prolapse surgery with an emphasis on newer developments in this area.

Recent Findings

  1. 1.

    More severe stages of prolapse are positively correlated with obstructive symptoms [Am J Obstet Gynecol 185:1332–1337, 2001], but not with other LUTS [Adv Urol 2013:5673753, 2013, Eur J Obstet Gynecol Reprod Biol 177:141–145, 2014, Am J Obstet Gynecol 199:683, 2008, Int Urogynecol J 21:1143–1149, 2010].

     
  2. 2.

    One-week ambulatory pessary trial is an effective way to approximate postoperative results—one study correctly predicted persistent urgency and frequency in addition to occult stress urinary incontinence in 20% of study population [Obstet Gynecol Int 2012:392027, 2012].

     
  3. 3.

    No preoperative overactive bladder (OAB) symptom was the best predictor for the absence of de novo OAB symptoms postoperatively [Int Urogynecol J 21:1143–1149, 2010].

     
  4. 4.

    Urge incontinence patients respond favorably to sacral neuromodulation [Neurourol Urodyn 26: 29–35, 2007], botulinum toxin, and anticholinergic therapy [Res Rep Urol 8:113–122, 2016 , N Engl J Med, 367:1803–1813, 2012].

     
  5. 5.

    Primary bladder outlet obstruction (BOO) can be treated effectively with alpha antagonists or anticholinergics, timed voiding, and pelvic physiotherapy as first-line therapy.

     

Summary

Counseling regarding postoperative LUTS is key when planning POP surgery. A thorough understanding of patient history is crucial to successful repair. Patients with significant preoperative symptoms, history of neurologic disease, pelvic floor dysfunction, bladder neck obstruction, or higher stages of anterior wall prolapse may be higher risk for postoperative LUTS. UDS with or without reduction and an ambulatory pessary trial can help prognosticate. Patients will likely maintain a positive therapeutic relationship postoperatively for LUTS if counseled preoperatively.

Keywords

Pelvic organ prolapse surgery Urodynamics LUTS Female incontinence Female voiding dysfunction Complications Overactive bladder Frequency Urgency Urge incontinence Overactive bladder 

Notes

Compliance with Ethical Standards

Conflict of Interest

Annie Chen, Brian McIntyre, and Elise J.B. De each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Stony Brook Medicine Department of UrologyStony BrookUSA
  2. 2.Massachusetts General Hospital—Harvard Medical SchoolBostonUSA

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