The association of pelvic organ prolapse with overactive bladder, other lower urinary tract symptoms (LUTS), and the natural history of those symptoms is not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and LUTS.
Primary aims were to determine the baseline association between LUTS and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse. Secondary aims were to explore associations between LUTS and prolapse treatment. We hypothesized that (1) prolapse is associated with the presence of LUTS, (2) LUTS are stable over time in patients with and without prolapse, and (3) prolapse treatment is associated with LUTS improvement.
Women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study with adequate 12-month follow-up data were included. Prolapse and LUTS treatment during follow-up was guided by standard of care. Outcome measures included the LUTS Tool total severity score (in addition to overactive bladder, obstructive and stress urinary incontinence subscales) and Urogenital Distress Inventory Short Form (UDI-6). Prolapse (yes/no) was defined primarily when POP-Q points Ba, C or Bp were >0 (beyond the hymen). Mixed effects models with random effects for patient slopes and intercepts were fitted for each LUTS outcome and prolapse predictor, adjusted for other covariates. The study had >90% power to detect differences as small as 0.4 SD for less prevalent group comparisons (e.g., prolapse versus not).
Three hundred seventy-one women were analyzed, including 313 (84%) with no prolapse and 58 (16%) with prolapse. Women with prolapse were older (64.6±8.8 vs. 55.3±14.1 years, p<.001) and more likely to have prolapse surgery (28% vs. 1%, p<.001) and pessary treatment (26% vs. 4%, p<.001) during the study. Average baseline LUTS Tool total severity scores were lower (fewer symptoms) for participants with prolapse compared to those without (38.9±14.0 vs. 43.2±14.0, p=0.036), but there were no differences in average scores between prolapse groups for other scales.For all urinary outcomes, average scores were significantly lower (improved) at 3- and 12-months compared to baseline (all p<0.05). In mixed effects models, there were no statistically significant interactions between POP measure and visit or time-dependent prolapse treatment groups (p>0.05 for all regression interaction coefficients). The LUTS Tool obstructive severity score had a statistically significant positive association with POP-Q Ba, Bp, and point of maximum vaginal descent (MVD). The LUTS Tool total severity scale had a statistically significant negative association with POP-Q Ba and MVD prolapse. No other associations between prolapse and LUTS were significant (p>0.05 for all regression coefficients). Symptom differences between prolapse groups were small: all regression coefficients (interpretable as additive percent change in each score) were between -5 and 5 (SD of outcomes ranged 14.0 to 32.4).
Among treatment-seeking women with urinary symptoms, obstructive symptoms were positively associated with prolapse, and overall LUTS severity was negatively associated with prolapse. LUTS Tool scores improved over 12 months regardless of prolapse status, including those with treated prolapse, untreated prolapse and without prolapse.
American journal of obstetrics and gynecology. 2022 Aug 04 [Epub ahead of print]
Joseph T Kowalski, Jonathan B Wiseman, Abigail R Smith, Margaret E Helmuth, Anne Cameron, John O L Delancey, Whitney K Hendrickson, J Eric Jelovsek, Anna Kirby, Karl Kreder, H Henry Lai, Margaret Mueller, Nazema Siddiqui, Catherine S Bradley, Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study Group
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: ., Arbor Research Collaborative for Health, Ann Arbor, MI., University of Michigan, Ann Arbor, MI., Division of Urogynecology, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT., Duke University Medical Center, Durham, NC., University of Washington Medical Center, Seattle, WA., Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA., Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO., Northwestern University - The Feinberg School of Medicine, Chicago, IL., Duke University, Durham, NC., Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.