There are many reports that overactive bladder (OAB) with pelvic organ prolapse (POP) improves in about half the cases after the POP is repaired by surgery or pessary. However, it is unclear in which cases OAB improves after surgery. Therefore, we investigated whether the preoperative interview and OAB symptom scores (OABSS) could predict postoperative OAB symptoms.

Patients who underwent POP repair surgery between January 2017 and December 2022 were enrolled in this study. Their age, BMI, POP severity, and OABSS preoperatively and 3 months after POP surgery were examined retrospectively.

Among the 306 cases available for the study, 151 (49.3%) had OAB. Mean age was 74.1±7.2 (47-90) years, mean BMI was 24.2±3.3 (16.9-36.5) kg/m2, mean number of births was 2.3±0.8 (0-4). There was no statistically significant difference between those without OAB.
Of the 130 cases with confirmed POP and OAB symptom onset accurately, 43 were classified as those with OAB symptoms more than six months before subjective POP symptoms (Group A) and 87 cases included those without (Group B). In Group A, Mean age was 73.5±7.1 (52-89) years, mean BMI was 24.7±3.7 (16.9-36.5)kg/m2, mean number of births was 2.2±0.7 (0-4). In Group B, Mean age was 74.5±7.2 (47-86) years, mean BMI was 24.0±2.3 (20-30.9) kg/m2, mean number of births was 2.3±0.7 (1-4). There were  no statistically significant difference between two groups. Preoperative OABSS in Group A were 0.93±0.56, 1.62±0.99, 3.15±0.88, 2.21±1.40 and the total score was 8.02±2.82. Those in Group B were 1.16±0.48, 1.77±1.05, 3.30±0.98, 2.58±1.40 and the total score of OABSS was 8.79±2.64. A statistically significant difference was observed only in daytime urinary frequency between the two groups. Postoperative OABSS in Group A were 0.55±0.54, 1.16±0.86, 1.07±1.23, 0.94±1.23 and the total score of OABSS was 3.71±2.89. Those in Group B were 0.93±0.40, 1.56±1.00, 2.16±1.61, 1.86±1.55 and the total score was 6.47±3.65. There were statistically significant differences in all scores between the two groups.
The postoperative OAB symptoms were resolved or improved in 98 cases and either persisted or worsened in 32 cases. The OAB symptoms were either resolved or improved in 21 cases of Group A (48.8%), whereas they were in 77 cases of Group B (88.5%).

Among POP patients with OAB, in nearly 90% cases who developed OAB at the same time as or after POP awareness had postoperative improvement of OAB symptoms. However, less than half of patients who had OAB symptoms from more than six months before the onset of POP symptoms showed postoperative improvement.

"POP-induced OAB" is ameliorated by POP repair and "POP-induced OAB" can be identified by asking patients about the symptom onset of OAB symptoms in detail.

Tomoe H. Improvement of overactive bladder symptoms after tension-free vaginal mesh operation in women with pelvic organ prolapse: Correlation with preoperative urodynamic findings. Int J Urol. 2015 Jun; 22(6):577-80..

Continence 7S1 (2023) 100853
DOI: 10.1016/j.cont.2023.100853