The surgical effect on overactive bladder symptoms in women with pelvic organ prolapse

Abstract

This study aimed to explore the effect of pelvic reconstruction surgery on the relation of pelvic organ prolapse (POP) and overactive bladder (OAB) and the impact of preoperative vaginal oestrogen supplement on vaginal tissue. A total of 100 postmenopausal women with symptomatic POP who underwent pelvic reconstruction surgery (laparoscopic sacrocolpopexy or transvaginal mesh) were enrolled in this study. Preoperative vaginal oestrogen was prescribed in 28 cases. The evaluation tools consisted of POP-Q, urodynamic study, Overactive Bladder Symptom Score (OABSS), and urinary NGF. Vaginal maturation index and vaginal specimens for hormone receptors study were investigated during operation to evaluate the effect of topical oestrogen. Follow-up assessments were performed at 1, 3, and 6 months after surgery. Preoperatively, 58 (58%) were POP with OAB. After reconstruction surgery, the OABSS decreased significantly (6.87 ± 0.85 vs 3.77 ± 0.61, p < 0.001) at postoperative 6 months in the group. Remarkable increasing trends of urinary NGF levels are noted till 3 months postoperatively, then decreasing to the baseline level at 6 months postoperative follow-up. Remarkable decrease of mRNA of the androgen receptor and significant higher expression of progesterone receptor (PR) were noted after use of the vaginal oestrogen cream. The severity of OAB in the POP women shows moderate degree according to OABSS. Pelvic reconstruction surgery can significantly improve the OAB symptoms. The surgery induced inflammation effect lasts for about 6 months. Short-term preoperative supplement of topical oestrogen brings alterations of the vaginal epithelium.

Figure 1

Study recruitment and follow-up.

Figure 2

The changes of overactive bladder symptoms score (OABSS) at baseline and postoperative follow-up in (A) POP without OAB and (B) POP with OAB groups. One-way analysis of variance (ANOVA) was used to test for statistical significance between baseline, 1, 3 and 6 months postoperatively group. (Group I: baseline; Group II: 1 month; Group III: 3 months; Group IV: 6 months). Urgency: Group I vs Group II, p = 0.049; Group I vs Group III, p < 0.001; Group I vs Group IV, p < 0.001. Urgency Incontinence: Group I vs Group III p = 0.037; Group I vs Group IV, p = 0.046. Total score: Group I vs Group III, p < 0.001.; Group I vs Group IV, p < 0.001. *p < 0.05; *** p < 0.001. POP pelvic organ prolapse, OAB overactive bladder.

Figure 3

Relative expression of hormone receptors mRNA in vaginal wall biopsies of patients. (A) oestrogen receptor-α (B) oestrogen receptor-β (C) progesterone receptor (D) androgen receptor. *p < 0.05.

Figure 4

(A) Immunohistochemical staining of oestrogen receptor-α (A,B), oestrogen receptor-β (C,D), progesterone receptor (E,F), androgen receptor (G,H) of the vaginal wall in each group. (Control group: post-menopausal women untreated with vaginal premarin cream before surgery Premarin group: postmenopausal women used vaginal premarin cream at least 2 weeks preoperatively). Red arrows in (F) show the higher amount of PR positively stained cells (brown color) compared to the biopsy from control (E). (B) Immunohistochemistry quantification as percent of (A) oestrogen receptor-α (B) oestrogen receptor-β (C) progesterone receptor (D) androgen receptor positive cells in the vaginal wall between the control and intervention groups. *p < 0.05; ** p < 0.01.

Figure 4

(A) Immunohistochemical staining of oestrogen receptor-α (A,B), oestrogen receptor-β (C,D), progesterone receptor (E,F), androgen receptor (G,H) of the vaginal wall in each group. (Control group: post-menopausal women untreated with vaginal premarin cream before surgery Premarin group: postmenopausal women used vaginal premarin cream at least 2 weeks preoperatively). Red arrows in (F) show the higher amount of PR positively stained cells (brown color) compared to the biopsy from control (E). (B) Immunohistochemistry quantification as percent of (A) oestrogen receptor-α (B) oestrogen receptor-β (C) progesterone receptor (D) androgen receptor positive cells in the vaginal wall between the control and intervention groups. *p < 0.05; ** p < 0.01.

Figure 5

The changes in mean vaginal maturation index (VMI) score.