Can surgical reconstruction of vaginal and ligamentous laxity cure over active bladder symptoms in women with pelvic organ prolapse?

The objective of this interventional study was to examine extent and intensity of the coexistence of overactive bladder (OAB) symptoms in women with pelvic organ prolapse (POP) and to evaluate the likelihood of OAB symptom improvement after surgical POP reconstruction in a period of two years.

The effectiveness of the transvaginal, single-incision Elevate@ technique for anatomical cure of anterior/apical and posterior/apical vaginal prolapse has been previously reported following a prospective, multicenter study. This technique utilizes mesh arms attached to the sacrospinous ligaments to recreate apical ligamentous support. Using the same sample population from the multicenter study (n=281), this sub-analysis focuses on estimating the extent of comorbidity between POP and OAB symptoms, as well as the effects of subsequent pelvic floor reconstruction on OAB symptoms in a long duration. Assessments of POP and OAB symptom severity before and after surgery at 6, 12 and 24 months were obtained with the pelvic floor distress inventory (PFDI) questionnaire.

Preoperatively, 70% of all POP patients reported OAB moderate to severe symptoms, with almost half (49.5%) noting severe OAB bother ("quite a bit") of one or more of the classic OAB symptom domains on the PFDI: "daytime urinary frequency", "urinary urgency", "urinary urgency incontinence", and/or "nocturia". In fact, across all 4 OAB symptom domains evaluated, there were significantly more severe ("quite a bit") symptoms than moderate ("moderately") or mild ("somewhat"); 26-31%, 13-21%, and 17-19%, respectively. In patients with symptomatic POP > Stage 2, there was no relationship between further degree of prolapse and presence of severity of OAB symptoms. However, patients with POP Stage 2 versus Stage 3-4 had significantly more complaints regarding the items "daytime urinary frequency" and "urinary urgency incontinence". Pelvic floor reconstructive surgery resulted in a significant improvement of all OAB symptoms that seems to be stable over time. The cure rate of moderate-to-severe OAB complaints ranged between 60 - 80%, which was a durable improvement noted throughout 24 months.

POP is to a high degree accompanied with moderate-to-severe OAB complaints. Significant long-lasting improvements in bothersome OAB symptoms occur after adequate surgical reconstruction of anterior/apical and posterior/apical vaginal support. This article is protected by copyright. All rights reserved.

BJU international. 2018 Jun 16 [Epub ahead of print]

Bernhard Liedl, Klaus Goeschen, Suzette E Sutherland, Jean-Paul Roovers, Alexander Yassouridis

Pelvic Floor Centre Planegg, Urologische Klinik Planegg, Germeringer Strasse 32, D-82152, M√ľnchen-Planegg., Medical School of Hannover, Germany, 67433, Neustadt, Mandelring 5B., Department of Urology, University of Washington School of Medicine, Seattle, WA, USA., Gynaecology, Academic Medical Center/, University of Amsterdam, Melbergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Member of Ethics Committee, Faculty of Medicine, Ludwig-Maximilian University of Munich.