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

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.

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Re: The Effect of Pelvic Organ Prolapse Severity on Improvement in Overactive Bladder Symptoms after Pelvic Reconstructive Surgery

The Journal of Urology ◽

10.1016/j.juro.2014.08.078 ◽

2014 ◽

Vol 192 (5) ◽

pp. 1490-1491

Author(s):

Alan J. Wein

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Reconstructive Surgery ◽

Pelvic Organ ◽

Pelvic Reconstructive Surgery ◽

Overactive Bladder Symptoms ◽

Bladder Symptoms

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The effect of pelvic organ prolapse severity on improvement in overactive bladder symptoms after pelvic reconstructive surgery

International Urogynecology Journal ◽

10.1007/s00192-012-2000-z ◽

2012 ◽

Vol 24 (8) ◽

pp. 1303-1308 ◽

Cited By ~ 24

Author(s):

Jeannine M. Miranne ◽

Vrishali Lopes ◽

Cassandra L. Carberry ◽

Vivian W. Sung

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Reconstructive Surgery ◽

Pelvic Organ ◽

Pelvic Reconstructive Surgery ◽

Overactive Bladder Symptoms ◽

Bladder Symptoms

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Pelvic organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP)

International Urogynecology Journal ◽

10.1007/s00192-021-04920-w ◽

2021 ◽

Author(s):

Päivi K. Karjalainen ◽

Anna-Maija Tolppanen ◽

Nina K. Mattsson ◽

Olga A.E. Wihersaari ◽

Jyrki T. Jalkanen ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Symptom Severity ◽

Pelvic Organ ◽

Population Based ◽

Urinary Frequency ◽

Posterior Compartment ◽

Posterior Repair ◽

Apical Compartment ◽

Bothersome Symptom

Abstract Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations. Results At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%. Conclusions OAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

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Prevalence and clinical predictors for early post-operative urinary retention in patients undergoing pelvic reconstructive surgeries: a prospective cohort study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181334 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1452

Author(s):

Annie P. Vijjeswarapu ◽

Vaibhav Londhe ◽

Mahasampath Gowri ◽

Aruna Kekre ◽

Nitin Kekre

Keyword(s):

Cohort Study ◽

Pelvic Organ Prolapse ◽

Urinary Retention ◽

Prospective Cohort Study ◽

Reconstructive Surgery ◽

Prospective Cohort ◽

Pelvic Organ ◽

P Value ◽

Pelvic Reconstructive Surgery ◽

Clinical Predictors

Background: Pelvic organ prolapse (POP) has a significant impact on quality of life. Post-operative voiding dysfunction is seen in 2.5 to 24% of patients following pelvic reconstructive surgery. Risk factors like age of the patient, size of the genital hiatus and stage of prolapse are known to be associated with early post-operative voiding disorders.Methods: This is a prospective cohort study done in Christian Medical College, Vellore over one year. Patients with stage II to IV pelvic organ prolapse who underwent pelvic reconstructive surgery were observed post operatively for covert and overt urinary retention. Inability to void accompanied by pain and discomfort is defined as overt retention. Early post-operative urinary retention (POUR) is retention of urine in the first 72 hours postoperatively. Covert retention is defined as a non-painful bladder with chronic high post void residue. Chi- square test or Fisher’s exact test was used to assess the association between the clinical predictors and early post-operative urinary retention in univariate analysis.Results: In this study, 75 patients were recruited. Nine patients had POUR. Among the patients who had post-operative urinary retention, 77.78% had stage III pelvic organ prolapse (n=7). P value was 0.042. The prevalence of early POUR after pelvic reconstructive surgery was 12.85 % (n=9). A 55.55% had covert retention (n=5) and 44.44% patients had overt retention (n=4).Conclusions: The prevalence of early POUR after pelvic reconstructive surgery was 12.85%. Stage of the prolapse was an independent predictor for early postoperative urinary retention.

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A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the pelvic organ prolapse quantification system

International Urogynecology Journal ◽

10.1007/s00192-005-1347-9 ◽

2005 ◽

Vol 17 (1) ◽

pp. 46-49 ◽

Cited By ~ 32

Author(s):

Mark E Vierhout ◽

Jackie Stoutjesdijk ◽

Johan Spruijt

Keyword(s):

Pelvic Organ Prolapse ◽

Reconstructive Surgery ◽

Pelvic Organ ◽

Pelvic Reconstructive Surgery ◽

Pelvic Organ Prolapse Quantification ◽

Intraoperative Evaluation

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Reasons for delay in decision making and reaching health facility among obstetric fistula and pelvic organ prolapse patients in Gondar University Hospital, Northwest Ethiopia

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i2.21795 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

Mulat Adefris ◽

Solomon Mekonnen ◽

Kiros Terefe ◽

Abebaw Addis ◽

Azmeraw Adigo ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Obstetric Fistula ◽

Social Stigma ◽

Pelvic Organ ◽

Northwest Ethiopia ◽

University Hospital ◽

Time Of Arrival ◽

Financial Problem ◽

Cross Sectional ◽

Gondar University Hospital

Aims: To assess reasons for the delay in getting treatment of women with obstetric fistula and pelvic organ prolapse at Gondar University Hospital. Methods: A hospital based cross-sectional study was conducted among 384 women. Delay was evaluated by calculating symptom onset and time of arrival to get treatment at University of Gondar Hospital. Regression analysis was conducted to elicit predictors of delay for treatment. Results: Of the total 384 participants 73(19.1%) were fistula cases and 311 (80.9%) were pelvic organ prolapse. The proportion of women who delayed for treatment of pelvic organ prolapse was 82.9%, and that of obstetric fistula was 60.9%. Women who had fear of disclosure due to social stigma (AOR=2; 1.03, 3.9), and financial problem (AOR=1.97; 1.01, 3.86) were associated with delay to seek treatment for pelvic organ prolapse. While increasing age (AOR =1.12; 1.01, 1.24)and divorce (AOR = 16.9; 1.75, 165.5) were associated with delay to seek treatment among obstetric fistula cases, Conclusions: A high proportion of women with pelvic organ prolapse and Obstetric fistula were delayed to seek treatment. Fear of disclosure due to social stigma and financial problem were the major factors that contributed for delay to seek treatment for pelvic organ prolapse. While increasing age and divorce were the predictors for delay to seek treatment for obstetrics fistula patients.

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