Women with pelvic organ prolapse (POP) often have concomitant overactive bladder (OAB) which may be associated with the abnormal position of the bladder. Despite symptom improvement in some women after POP repair, OAB symptoms can persist in up to 40% of women. While sacral neuromodulation (SNM) has been shown to be efficacious in treating OAB symptoms refractory to medical therapy, its efficacy following POP repair is not well described. We sought to determine the efficacy of SNS placement in women with refractory OAB who have undergone prior anterior and/or apical POP repair.

A retrospective review from a single institution was performed on all SNS lead placements in women from 1998 to 2017. Women with prior anterior and/or apical POP repair were compared to women without prior POP repair. Demographic data was obtained. Efficacy was defined as 50% improvement in voiding diary parameters with progression to pulse generator implantation (stage 2 SNS), and records were also investigated for device explantation rates and need for subsequent therapy. Women who had undergone prior POP repair without correction of the anterior and/or apical vaginal compartments were not included in the prior POP repair group.

Of 234 patients, 37 (16%) had a prior anterior and/or apical POP repair. Compared to patients without prior POP repair, these patients were significantly older (67 vs 59, p=0.01) and more likely to have a history of myocardial infarction (14% vs 3%, p=0.01), but were similar in BMI, race, smoking status, and other comorbidities including diabetes, stroke, and cardiovascular disease (Table 1). Subjects in the prior POP repair group did not differ with respect to progression to stage 2 SNS (73% vs 66%, p=0.45), revision surgery (11% vs 11%, p=0.95), explantation rates (14% vs 17%, p=0.81), or need for subsequent therapies (Table 2).

Patients with anterior and/or apical POP repair prior to SNS placement had similar rates of progression to stage 2 SNS and need for subsequent therapies compared to those who did not have prior POP repair, indicating equivalent efficacy. The need for revision surgery and explantation rates was also similar between groups.

Our study suggests that SNS is as effective in women with OAB refractory to pharmacotherapy who have undergone prior anterior and/or apical POP repair as it is in women who have not undergone prior POP repair.