Overactive bladder (OAB) is a clinical disorder of the lower urinaty tract characterized by urgency, frequency, with or without urinary incontinence, usually accompanied by nocturia in the absence of infection or other obvious pathology [1]. Initial diagnosis and management is usually clinical and conservative, based on patient's symptoms and complaints. Sometimes, further investigation such as urodynamic studies is required in order to assess more complicated cases or those refractory to treatment, however this is invasive and resource consuming. Several studies showed that the prevalence of OAB symptoms was greater in patients with pelvic organ prolapse (POP) than without POP [2]. Bladder outlet obstruction due to POP is likely to be the most important mechanism OAB symptoms are provoked. Current literature has demonstrated that there are certain biomarkers have been proposed as diagnostic tools and may be used to create individual patient profiles. Assessing the diagnostic performance of biomarkers would better outline their utility in OAB women [3]. The purpose of this study was to compare outcomes in OAB symptoms in women with POP & OAB treated with native tissue vaginal surgery for POP.

This prospective observational study was approved by our Institutional Ethics Committee. Written informed consent was obtained from all the women enrolled.  A total of 94 subjects were included. The OAB and control group comprised of 45 and 49 participants, respectively. Demographic data such as age and body mass index (BMI), parity, birth weight, instrumental birth, menopause status, smoking were collected from the study subjects. Women were included in the OAB or control group based on the presence or absence of OAB symptoms, as defined by An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Participants were excluded if they have had any previous pelvic surgery, radiotherapy, urinary tract infection, renal or hepatic disease, known cancer, neurologic or autoimmune disease, or any invasive OAB therapy. 
All participants filled in Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the vaginal symptoms were assessed with International Consultation on Incontinence Questionnaire- Vaginal Symptoms (ICIQ-VS). Post-operatively, the recurrence of anatomical prolapse was evaluated with the POP-Q system. The Patient Global Impression of Improvement (PGI-I) and Severity (PGI-S) scores were used to evaluate the patients' satisfaction after surgery. Patients’ sexual life was evaluated using the Sexual Quality of Life Questionnaire – female (SQOL-F). Statistics were performed using Microsoft EXCEL and JASP {JASP Team (2019). JASP (Version 0.11.1) [Computer software], Amsterdam, Netherlands}.

A total of 94 women were enrolled and distributed in two groups: a group with OAB (n = 45) and a control group (n = 49). Demographically, the mean age, the mean BMI, and the mean parity were 63±7.1 years, 30±4.6, and 3±1 children, and 61.8±8.6 years, 28.8±4.2, 2.4±0.7 children in the study and the control group, respectively. Pre-operatively, POP-Q Ba, C, TVL and Bp were 3±2.3, 2±4.5, 10±2.4, 0±0.6 and 3.1±2.9, 1.4±4.9, 10.2±1.5, and -0.4±2, respectively. Patient’s characteristics are displayed in Table 1. All patients had native tissue vaginal surgery under general or regional anesthesia in lithotomy position. All procedures were completed without any major complications and performed by two experienced surgeons. The mean POP-Q (Ba, C, TVL and Bp) measurement at 3-months after were -2.1±0.8, -5.3±3.6, 8.7±2.7, -1.9±0.7, and -2±0.9, -10±2.9, 9±1.5, -2±0.8 in OAB and control group, respectively (Table 1). 
Post-operatively, the ICIQ-FLUTS scores were significantly reduced in the Filling, the Voiding, and the Incontince domains both in the control and the study group (p<0.05) (Table 2). The mean total ICIQ-VS score was higher following surgery in the study group than controls (8.8±8.5 vs.5.78±5.78) despite the greater improvement regarding the POP-Q results. At 3 months follow-up, the mean PGI-S score was 1.5±0.9 and the mean PGI-I score was 1.8±1.3 and 1.28±0.58 and 1.7±1.03 in the OAB women and controls respectively (p>0.05). PGI-I score 1 and 2 was found in 80.5%, PGI-S score 1 was found in 72.2% in POP-OAB participants and 89.1% and 78.2% in POP women. The SQOL-F scoring was similar for the both groups. (see Table 2).

Irritative symptoms in OAB-POP patients appear to diminish after native-tissue surgery. Although there is in agreement with the relevant research, the field of OAB symptoms in women with prolapse is consistently intriguing, as POP treatment is not always related to the control of the bulk of the irritative symptoms. In most of the studies, at least 50% of the patients is not going to have adequate post-operative control of the OAB symptoms. Thus, further research is needed to clarify (i) the reasons why there is no post-operative universal treatment to OAB symptoms in POP/OAB patietns, (ii) which are the important parameters related to no symptom control, and (iii) which are the factors leading to de novo OAB symptoms.

Our findings suggest that in an consecutive case control study, native tissue POP surgery seems to be efficacious for the control of OAB symptoms in patients with POP and OAB. Further studies should be conducted in order to provide more robust data on association of POP management in OAB patients.

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