Pelvic organ prolapse (POP) is a non life-threatening condition that influences the quality of life of millions of women worldwide. Although POP affects up to 30% of the general female population, most of these women are asymptomatic and will probably never seek for medical help. However, recent statistics show that 17% of the population will have surgery for POP. Overactive bladder (OAB) is a syndrome characterized by urinary urgency, urge urinary incontinence, frequency, and/or nocturia. Women with symptoms of urinary incontinence suffer from OAB at a rate of 20-40%. Urodynamic studies in women with POP have shown that detrusor overactivity (DO) is identified in 10-50% of the cases. The management of women with concurrent POP & OAB depends on the degree of POP severity, the intensity of OAB symptoms, the patients and the clinicians preferences, and the burden of any comorbidities of the patient. Current literature indicates that up to 50% of women with POP & OAB are going to be cured from OAB symptoms after a successful surgical POP operation. However, it is under-investigated who is going to be the patient who will benefit from a surgical intervention, and what are the indicators of a successful treatment of OAB symptoms in a patient who presents with POP & OAB. The aim of this study is to analyse the pre-operative parameters that can predict the successful treatment of OAB symptoms in women with POP & OAB who undergo native-tissue surgical treatment.

This is a cross-sectional, single centre study performed in a Urogynecology unit of a Tertiary Academic Hospital. Consecutive women presenting with POP were asked to participate in the study. Inclusion criteria were: (1) age > 18-years-old, (2) Greek speakers, (3) symptomatic > POP-Q Grade 2 POP, (4) abnormal ICIQ-OAB score. Exclusion criteria were: (1) history of previous POP or incontinence surgery, (2) known neurologic disease. All the recruited women had (1) completed ICIQ-FLUTS and ICIQ-VS questionnaires, (2) pelvic flloor ultrasound (PFUS) assessment (evaluation of the urethral mobility and evaluation of the bladder wall thickness), and (3) full urodynamic studies (uroflowmetry, filling cystomanometry, pressure-flow studies, and urethral profilometry). Then, all patients had native-tissue surgical POP repair: women with anterior compartment prolapse had anterior colporraphy, women with posterior compartment prolapse had posterior colpoperineorraphy, women with uterine prolapse had vaginal hysterectomy and McCall culdoplasty, alone or in combination. All patients were evaluated 3 months after surgery with ICIQ-FLUTS and ICIQ-VS. Statistical analysis was performed with MedCalc. Paired t-test and χ2 were used to compare pre- and post-operative numerical and nominal results, respectively; a regression analysis was used to identify any factor related significantly with postoperative improvement of OAB symptoms. p<0.05 was considered statistically significant.

35 patients were recruited in the study. Mean age was 615±8.0 years, mean pre-operative ICS-FLUTS and ICIQ-VS score were 17.3±9.1, and 14.1±12.5, respectively. Significant (>Grade 2) anterior compartment prolapse, middle compartment prolapse and posterior compartment prolapse was found in 29/35 (82.3%), 33/35 (94.3%), 31/35 (88.6%) patients, respectively. PFUS identified 25/35 (71.4%) patients with increased urethral mobility, whereas 18/35 (51.4%) patients had mean BWT >6mm. 2/35 women had anterior repair only, and 33/35 women had combination of surgical procedures (anterior repair, posterior repair,vaginal hysterectomy, and/or Manchester’s procedure). Mean post-operative ICS-FLUTS and ICIQ-VS score were 6.2±7.4 and 4.6±5.4, respectively. There was statistically significant improvement in both questionnaires. Regression analysis identified high ICIQ-LUTS score and increased age as the main parameters related to persistence of symptoms.

Patient orientated approach to the management of women with pelvic floor disease implies that the treatment should address successfully all the symptoms that deteriorate womens’ quality of life. Unfortunately, in women with combined POP & OAB symptoms, only a small percentage of the patients will be satisfied from the surgical treatment postoperatively. The obscure pathophysiology of OAB is one of the main reasons for the inferiority of the medical interventions on these women. However, clinicians should provide sufficient data to the patients, in order for them to decide the type and the aggressiveness of their treatment after informed selection of the available options. The current study implies that elder women with more severe OAB symptoms are less likely to be cured of the OAB burden when they do decide to undergo surgical treatment of prolapse.

Surgical intervention in women with POP & OAB does not always cure OAB symptoms. Women with more severe OAB symptomatology and older women have diminished rates of cure of the OAB symptoms.

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