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

Abstract

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

Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system

“…[23,24] That is to say after surgical correction of POP, persistent and occult or new LUTS can be present. [25] Therefore, for those patients who are arranged for POP surgery, the postoperative LUTS should be taken care of. There are some tools to predict, counsel, and subsequently handle postoperative LUTS.…”

“…Due to its impact on the success of POP surgery, there are many articles available to address this issue. [25–32] The main findings include…”

“…patients need adequate counseling about postoperative LUTS when they are arranged for POP surgery. [25–32]…”

“…[34] Due to above findings, the recent trend seemed to favor the strategy to postpone the anti-incontinence surgery during POP surgery and perform a delayed (two-stage) continence procedure, if required. [24,25,27,31,34,35]…”

Pelvic Floor Physical Therapy and Women’s Health

“…Although most women are pleased with their surgical outcomes following repair, 25% require additional postoperative therapy [33]. Post-operative SUI due to poor pelvic floor muscle recruitment may be due to lack of training and coordination, as the patient most likely has not needed to perform a pelvic floor contraction since her prolapse became obstructive [34]. Post-operatively, lower urinary tract symptoms (LUTS) may also include increased daytime urgency and nocturia, in addition to other voiding or storage symptoms.…”