Women with severe anterior compartment prolapse have a higher likelihood of overactive bladder (OAB) and persistent urgency after surgery, according to investigators presenting at the International Continence Society 2020 virtual annual meeting.
In a study of 367 patients from 2 public hospitals in Spain, 197 (53.6%) had urgency and 145 (39.5%) urge urinary incontinence (UUI) prior to surgery. Women with more severe prolapse – Pelvic Organ Prolapse Quantification (POPQ) system stage 3 or stage 4 – had 4.3-fold and 12.9-fold increased odds for urgency, respectively, compared with women with POPQ stage 2, Irene Diez-Itza, MD, PhD, of University Hospital, Donostia in Gipuzkoa, Spain, reported in a video presentation. At 1 year after anterior prolapse repair surgery, 103 women (52.3%) had persistent urgency and 51 (25.9%) had persistent UUI. Women with POPQ stage 3 and 4 had 3.9- and 5.6-fold increased odds, respectively, for persistent urgency after surgery, compared with women with POPQ stage 2, Dr Diez-Itza reported. Another 18 (10.6%) and 12 (7.1%) patients had de novo urgency and UUI following surgery, respectively.
Age older than 60 years was another independent risk factor for urgency. Compared with women younger than 60 years, those aged 60-69 years and 70 years or older had 1.12- and 2.90-fold increased odds for preoperative urgency, respectively, and 1.96- and 5.59-fold increased odds for postoperative persistent urgency, respectively, Dr Diez-Itza reported.
The pathophysiology of OAB in women with pelvic organ prolapse is still unclear. Prolapse can cause bladder outlet obstruction, stretch receptors in the urothelium due to bladder distension, or open the urethra due to traction from a prominent cystocele, Dr Diez-Itza explained. Age-related changes in the bladder, pelvic floor tissues, and/or the nervous system contribute to the high prevalence of OAB in elderly women, she said.
Close to half of patients with OAB experienced improvement of urgency 1 year after surgery. Women with a preoperative POPQ stage 3 or higher or age 60 years or older, however, may be at higher risk for persistent urinary urgency, Dr Diez-Itza concluded. “This information may be useful to advise women with OAB undergoing [pelvic organ prolapse] surgery regarding postoperative expectations.”
Women with prior pelvic organ prolapse surgery, use of meshes, and concomitant surgery for stress urinary incontinence were excluded from the study.
Diez-Itza I, Martin-Martinez A, Uranga S, Avila M, Lekuona A, Garcia-Hernandez J. Can we predict overactive bladder resolution after prolapse surgery? Presented at: ICS 2020 Online, November 19-22, 2020. Presentation 68.