Systematic review of lower urinary tract symptoms occurring with pelvic organ prolapse

Abstract

Objective: To review lower urinary tract symptoms (LUTS), which include a large variety of bladder complaints, in women with simultaneous pelvic organ prolapse (POP). Methods: This article is a systematic review of the current literature on LUTS occurring simultaneously with POP following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Results: The prevalence of both conditions is high, but they occur more frequently together than can be explained by chance. It appears that POP is in some women causative of overactive bladder (OAB) symptoms, as in many women correction of the POP resolves the bladder symptoms and small studies of women with detrusor underactivity also demonstrate resolution of symptoms. The most plausible explanation for the relationship is that POP causes bladder outlet obstruction, which results in excess bladder irritability or poor contractility. However, not all women have resolution of their OAB symptoms and some women develop them de novo after POP repair, so this explanation requires more in depth study. Conclusions: Women with both LUTS and symptomatic POP should probably have their POP targeted, as its reduction either via surgery or pessary can correct the LUTS. However, no studies have addressed asymptomatic POP, so it is unclear if treating POP in these instances is of benefit.

Pre- versus Post-Menopausal Onset of Overactive Bladder and the Response to Vaginal Estrogen Therapy: A Prospective Study

“…Exclusion criteria include: pelvic prolapse ≥ II grade according to Pelvic Organ Prolapse (POP) System (POP-Q) classification, current UTI, history of cancer, pelvic irradiation, neurological condition affecting bladder function, diabetes, chronic inflammatory diseases, chronic kidney desease, hypertension, congestive heart failure, use of diuretics, alcohol or drug addictions, and uncontrolled psychiatric disorders. POP ≥ II grade may cause, other than bladder outlet obstruction, lower urinary tract symptoms, and bladder complaints mimiking OAB symptoms [ 14 ] and as such women with POP ≥ II grade were excluded from the study.…”

Is Urodynamic Study an Essential Step in Preoperative Evaluation of Women with Pelvic Organ Prolapse with Urinary Tract Dysfunction: Prospective Comparative Study

“…Also kinking and obstruction of the urethra can secondarily induce over activity of the detrusor muscle giving a clinical picture mimicking overactive bladder syndrome. These symptoms could also be present in patients and not attributed to the prolapse [6] .…”

Association between voiding lower urinary tract symptoms and findings on dynamic magnetic resonance imaging with regard to pelvic organs and their supportive structures

“…On the other hand, DU is caused by long‐standing untreated POP‐induced BOO 5 . The incidences of these conditions are variable in the literature, with 3%–33% of patients having BOO and 3%–41% having DU 1,6,7 . In addition, BOO is supposed to be a major pathophysiological factor of OAB in patients with POP 2 …”

“…5 The incidences of these conditions are variable in the literature, with 3%-33% of patients having BOO and 3%-41% having DU. 1,6,7 In addition, BOO is supposed to be a major pathophysiological factor of OAB in patients with POP. 2 Recently, dynamic magnetic resonance imaging (dMRI) has been used to elucidate the pathogenesis of POP as well as the pathophysiology of the lower urinary tract, sexual, and bowel dysfunction.…”