The association of symptoms of overactive bladder with pelvic organ prolapse and its improvement after pelvic reconstructive surgery

Abstract

Objectives: This study asseses the association of overactive bladder symptoms and pelvic organ prolapse severity and evaluates the effect of pelvic reconstructive surgery on overactive bladder (OAB) symptoms in women with pelvic organ prolapse (POP). It also looks into any pre and post-operative factors responsible for persistent postoperative OAB symptoms.
 Methods: This was a retrospective cross-sectional study conducted at the Aga Khan University Hospital, Karachi between 1st January 2014 and 31st December 2018. In this study women presenting with POP and concommitent OAB who underwent surgery for site specific defects, measured using Pelvic Organ Prolapse Quantification (POP-Q) staging system. OAB was defined as presence of urinary frequency, urinary urgency incontinence (UUI) and an affirmative response to item #15 and/or item #16 of the Pelvic Floor Distress Inventory (PFDI), which was used both pre and postoperatively. Primary outcome of the study was to find complete resolution or improvement of urinary frequency and UUI on the PFDI, 24 months after surgery. The secondary outcome was to see persistent OAB postoperatively and the factors associated with it.
 Results: Overactive bladder (OAB) symptoms improved significantly regardless of the severity of prolapse at 24 months postoperative period. Body mass index (BMI) and postoperative constipation were the only statistically significant variables associated with persistent OAB symptoms postoperatively.
 Conclusions: Surgical correction of POP results in significant improvement in symptoms of OAB, in all stages of POP and co-existing OAB. However women with high BMI and post-operative constipation may be prone to persistent frequency and/or UUI.
 doi: https://doi.org/10.12669/pjms.37.3.3312
 How to cite this:Abrar S, Rizvi RM, Zahid N. The association of symptoms of overactive bladder with pelvic organ prolapse and its improvement after pelvic reconstructive surgery. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3312
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process

“…The concept of lifelong OAB revisits this dynamic by suggesting that a background state of DO serves as a backdrop to which various anatomical factors, BPO among others, are added. This framework extends to other factors, such as sexual trauma in the childhood, 33 metabolic syndrome with a suggested common pathophysiological substrate, 34 and pelvic organ prolapse with evidence of transition from a bothersome to a subclinical OAB after pelvic reconstructive surgeries 35 . During this same transition phase, a hormonal‐related factor was also selected by the panel, the genitourinary syndrome of menopause where decrease in estrogen secretion leads to structural and functional changes in both the vaginal and bladder regions resulting in a decreased bladder capacity leading to an overt OAB 7 .…”

“…| 1053 suggested common pathophysiological substrate, 34 and pelvic organ prolapse with evidence of transition from a bothersome to a subclinical OAB after pelvic reconstructive surgeries. 35 During this same transition phase, a hormonal-related factor was also selected by the panel, the genitourinary syndrome of menopause where decrease in estrogen secretion leads to structural and functional changes in both the vaginal and bladder regions resulting in a decreased bladder capacity leading to an overt OAB. 7 The psychosocial factors originally suggested were replaced by the panel by the term psychological stress, a broad term that encompasses a multitude of situations that may be directly or indirectly related to the change in the OAB clinical perception threshold.…”