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

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.

Keywords: Overactive bladder; Pelvic organ prolapse; Pelvic organ prolapse surgery; Urgency urinary incontinence; Urinary frequency.

Fig. 1

Flowchart showing the selection of the study population. POP, pelvic organ prolapse; FINPOP, Finnish Pelvic Organ Prolapse Surgery Survey

Fig. 2

Association between the severity of overactive bladder symptoms and degree and compartment of prolapse at baseline. UUI, urgency urinary incontinence. Adjusted estimated marginal means with 95% confidence intervals for stages of individual compartments is shown. Stage 3 combines stages 3 and 4 for all compartments. For apical compartment, stage 1 combines stages 0 and 1

Fig. 3

Impact of surgery on overactive bladder symptoms. Impact of prolapse surgery on the overactive bladder symptom severity during the follow-up is shown. On the Y-axis, estimated marginal means (and their 95% confidence intervals) from linear generalized estimating equations multivariable model (scale 0–4, higher number indicating higher symptom bother: 0: symptom not present, 1: symptom present but not at all bothersome; 2: symptom somewhat bothersome; 3: symptom moderately bothersome; 4: symptom quite a bit bothersome). On the X-axis, follow-up points. On the left column, data stratified into two surgical groups. On the right, anterior/apical group stratified into three groups. The asterisk indicates P < 0.05, and NS indicates not significant (P > 0.05) for between-group comparison in an ordinal logistic generalized estimated equations model at different time points. P-values for within-group improvement and time*group interaction are reported for ordinal models. Between-group comparisons performed only for two groups (i.e., anterior/apical vs. posterior)

Fig. 4

Change in symptom severity from baseline to 6 months for each overactive bladder symptom stratified by baseline symptom severity in the anterior/apical and the posterior groups. Each image depicts change in symptom severity from baseline to 6 month’s follow-up stratified by baseline symptom severity: baseline symptom severity on the left and 6 months’ symptom severity on the right. The scale of symptom severity: 4: symptom quite a bit bothersome; 3: symptom moderately bothersome; 2: symptom somewhat bothersome; 1: symptom present but not at all bothersome; 0: symptom not present. The thickness of the arrow is proportional to percentage