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.

Reply to “The emperor has no clothes: OAB can be cured surgically”

“…As Karjalainen et al mentioned in the discussion section, their results are comparable with the literature in this regard [2,3]. Similarly, in the literature the improvements of OAB symptoms secondary to POP surgery have been attributed to the relief of bladder outlet obstruction caused by POP, decrease of post-void residual urine volume and alteration of sensory and barrier function of the urothelium [4].…”

Urinary Biomarkers and Overactive Bladder Symptoms Before and After Prolapse Surgery

“…Likewise, there was not a statistically significant difference in biomarkers between participants with OAB and those without or from preoperative biomarker levels to postoperative levels. A recent study by Wu et al 17 investigating NGF before and after prolapse surgery found an initial increase in NGF up to 3 months, followed by a decrease in NGF levels. This study used the Abcam human NGF ELISA, which has a similar detection range to the kit we used.…”

“…A recent study by Wu et al 17 investigating NGF before and after prolapse surgery found an initial increase in NGF up to 3 months, followed by a decrease in NGF levels. This study used the Abcam human NGF ELISA, which has a similar detection range to the kit we used.…”

Pelvic Organ Prolapse Syndrome and Lower Urinary Tract Symptom Update: What’s New?

“…One trial revealed an RR of more than 1, with values ranging from 1.1 to 10.3 in 61% of patients [11,16]. Symptoms of OAB improve independently using the surgical method [11,30]. This is supported by Foster et al [26], who showed how colpocleisis and reconstructive vaginal suspensions make no difference in OAB resolution one year after surgery.…”

“…According to these results, Malanowska et al demonstrated that surgery, including laparoscopic lateral suspension in patients with POP and OAB, could help relieve urinary symptoms [40]. Ling-Ying Wu et al, in their study, also confirmed the positive role in improving storage symptoms after reconstructive surgery [30]. OAB improved significantly after surgical correction of POP, according to Johnson et al, but age was connected with the persistence of storage symptoms, such as urgency [16].…”