Abstract
Patients with pelvic organ prolapse (POP) may present with a large combination of symptoms including overactive bladder (OAB) symptoms such as urgency, frequency, and urgency incontinence. The explanation as to why these symptoms are more prevalent in POP patients is not clearly understood, but there seems to be an overall agreement that prolapse-induced bladder outlet obstruction (BOO) may trigger bladder changes resulting in OAB symptoms. Presuming this to be true, many of the studies managing OAB in POP patients have focused on the surgical management of prolapse and its aftermath, which in many of the patients leads to improvement of OAB symptoms. This review presents the most recent studies and evidence looking at management of OAB in the face of POP and seeks to evaluate if there is any association between prolapse severity and OAB symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG. 2005;112:971–6.
Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.
Ali P, Higgs P, Smith A. Correlation between urogenital symptoms and pelvic organ prolapse quantification (POP-Q) findings in women. Neurourol Urodyn. 2006;25:523–4.
Ganz ML, Smalarz AM, Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, et al. Economic costs of overactive bladder in the United States. Urology. 2010;75(3):526–32.
•• de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn. 2010;29:30–9. This is a well-written comprehensive review looking at the pathophysiology of OAB in POP patients and its management options.
• Leng WW, Davies BJ, Tarin T, Sweeney DD, Chancellor MB. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol. 2004;172:1379–81. This paper provides evidence of the correlation between prolonged bladder outlet obstruction and a greater incidence of persistent OAB symptoms in urethrolysis patients.
Thakar R, Stanton S. Management of genital prolapse. BMJ. 2002;324:1258–62.
Atnip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):541–63.
Clemons JL, Aguilar VC, Tillinghast TA, et al. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190:1025–9.
Fernando RJ, Thakar R, Sultan AH, et al. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108:93–9.51.
Ramsay S, Mai Tu L, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J. 2016;27:1201–7.
Salvatore S, Serati M, Ghezzi F, et al. Efficacy of tolterodine in women with detrusor overactivity and anterior vaginal wall prolapse: Is it the same? BJOG. 2007;114:1436–8.
Miranne JM, Lopes V, Carberry CL, Sung VW. The effect of pelvic organ prolapse severity on improvement in overactive bladder symptoms after pelvic reconstructive surgery. Int Urogynecol J. 2013;24:1303–8.
• Fletcher SG, Haverkorn RM, Yan J, Lee JJ, Zimmern PE, Lemack GE. Demographic and urodynamic factors associated with persistent OAB after anterior compartment prolapse repair. Neurourol Urodyn. 2010;29:1414–8. This paper addresses preoperative urodynamic factors and how these may affect surgical prolapse repair outcomes specifically regarding OAB symptoms postoperatively.
Basu M, Wise B, Duckett J. Urgency resolution following prolapse surgery: is voiding important? Int Urogynecol J. 2013;24:1309–13.
Sun Kim M, Hoon Lee G, Duc Na E, Hyon Jang J, Chul KH. The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse. Obstet Gynecol Sci. 2016;59(3):214–9.
Costantini E, Lazzeri M, Zucchi A, Mearini L, Fragala E, Del Zingaro M, et al. Urgency, detrusor overactivity and posterior vault prolapse in women Who underwent pelvic organ prolapse repair. Urol Int. 2013;90:168–73.
de Boer TA, Kluivers KB, Withagen MI, Milani AL, Vierhout ME. Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery. Int Urogynecol J. 2010;21:1143–9.
Digesu GA, Salvatore S, Chaliha C, Athanasiou S, Milani R, Khullar V. Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1439–43.
Dieter AA, Edenfield AL, Weidner AC, Siddiqui NY. How does site of pelvic organ prolapse repair affect overactive bladder symptoms? Fem pelvic medicine and reconstructive. Surgery. 2014;20:203–7. This paper provides insight into whether women undergoing prolapse repair experience improvement of OAB symptoms regardless of site compartment site repaired.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Juan Guzman-Negron declares no potential conflicts of interest.
Sandip Vasavada reports personal fees from Medtronic and Axonics.
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.
Additional information
This article is part of the Topical Collection on Female Urology
Rights and permissions
About this article
Cite this article
Guzman-Negron, J., Vasavada, S. Management of Overactive Bladder in the Face of High Grade Prolapse. Curr Urol Rep 18, 12 (2017). https://doi.org/10.1007/s11934-017-0662-2
Published:
DOI: https://doi.org/10.1007/s11934-017-0662-2