Predictive factors for persistence of preoperative overactive bladder symptoms after transvaginal mesh surgery in women with pelvic organ prolapse

Abstract

Background: We aimed to evaluate the effect of transvaginal mesh surgery on overactive bladder symptoms in women with pelvic organ prolapse and to identify predictive factors for persistence of a preoperative overactive bladder after surgery. Materials and Methods:We retrospectively evaluated 102 patients who underwent transvaginal mesh surgery. All patients had stage 2 or greater pelvic organ prolapse accompanied by cystocele. The Overactive Bladder Symptom Score, International Prostate Symptom Score, uroflowmetry, and postvoid residual urine volume were evaluated preoperatively and 6 months postoperatively. To identify predictive factors for the persistence of a preoperative overactive bladder after surgery, preoperative parameters were statistically compared between patients with and without the persistence of preoperative overactive bladder symptoms. Receiver operator characteristic curves were generated, and the area under the curve was calculated.Results: Preoperatively, 54 women (53%) had an overactive bladder. After surgery, the symptoms disappeared in 34 (63%) and persisted in 20 (37%) women. There were no significant differences in preoperative parameters including age, body mass index, parity, or severity of pelvic organ prolapse between patients with and without persistent preoperative overactive bladder. Preoperative Overactive Bladder Symptom Score and International Prostate Symptom Score were significantly higher in patients with persistent preoperative overactive bladder symptoms. The International Prostate Symptom Score storage subscore had the highest area under the curve, with a cutoff value of 9.5. Conclusion: Transvaginal mesh surgery eliminates overactive bladder symptoms inabout two-thirds of pelvic organ prolapse patients. The preoperative International Prostate Symptom Score storage subscore was the most useful predictive factor for the persistence of preoperative overactive bladder symptoms after surgery. K E Y W O R D S female, International Prostate Symptom Score, overactive bladder, pelvic organ prolapse, transvaginal mesh surgery

Presurgical bladder wall thickness is a useful marker to predict the postsurgical improvement of symptoms in patients with pelvic organ prolapse‐related overactive bladder

“…1 Pelvic organ prolapse (POP) is a major health-care problem that impairs the quality of life in women, and many urologists support the opinion that patients with POP often experience OAB symptoms. [2][3][4] Several reports revealed that transvaginal POP repairs, such as transvaginal mesh (TVM) surgery, are effective treatment tools, and they lead to the disappearance or improvement in OAB symptoms. 2,3,5,6 However, only approximately 75% to 79% of patients experience such clinical effects of TVM surgery for OAB symptoms; conversely, >20% of patients experience worsening or no changes in symptoms after TVM surgery.…”

“…[2][3][4] Several reports revealed that transvaginal POP repairs, such as transvaginal mesh (TVM) surgery, are effective treatment tools, and they lead to the disappearance or improvement in OAB symptoms. 2,3,5,6 However, only approximately 75% to 79% of patients experience such clinical effects of TVM surgery for OAB symptoms; conversely, >20% of patients experience worsening or no changes in symptoms after TVM surgery. 3,4 Therefore, many investigators attempted to define predictive markers for the improvement in urinary conditions, including OAB symptoms, after surgery.…”

“…[2][3][4]7 Previous studies used the severities of preoperative subjective symptoms, including International Prostate Symptom Score, overactive bladder symptom score (OABSS), and urodynamic examination data, as useful preoperative predictors. [2][3][4]7 However, since the examination exclusively based on subjective symptoms cannot evaluate objective findings, such as detrusor overactivity and bladder outlet obstruction, and urodynamic tests are invasive and carry the risk of urinary tract infections, noninvasive and effective predictors of surgery outcomes are needed. 2,8 The measurement of bladder wall thickness (BWT) is supposedly a useful noninvasive parameter to evaluate the lower urinary tract function.…”

“…[2][3][4]7 However, since the examination exclusively based on subjective symptoms cannot evaluate objective findings, such as detrusor overactivity and bladder outlet obstruction, and urodynamic tests are invasive and carry the risk of urinary tract infections, noninvasive and effective predictors of surgery outcomes are needed. 2,8 The measurement of bladder wall thickness (BWT) is supposedly a useful noninvasive parameter to evaluate the lower urinary tract function. 9,10 In fact, BWT was significantly correlated with clinical parameters, symptom scores, and uroflowmetry results under obstructive bladder conditions.…”

“… 1 Pelvic organ prolapse (POP) is a major health‐care problem that impairs the quality of life in women, and many urologists support the opinion that patients with POP often experience OAB symptoms. 2 , 3 , 4 Several reports revealed that transvaginal POP repairs, such as transvaginal mesh (TVM) surgery, are effective treatment tools, and they lead to the disappearance or improvement in OAB symptoms. 2 , 3 , 5 , 6 …”