DOI: 10.4103/pjog.pjog_28_26 ISSN: 0116-6069

Prospective evaluation of overactive bladder symptoms in a cohort of patients undergoing vaginal hysterectomy and anterior colporrhaphy for advanced pelvic organ prolapse

Ryan Joseph Lirazan, Almira J. Amin-Ong
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Abstract:

BACKGROUND:

Pelvic organ prolapse (POP) is often accompanied by bothersome symptoms of overactive bladder (OAB), namely urinary frequency, urgency, nocturia, and urgency incontinence. Improvement of OAB-related symptoms has been observed after surgical and nonsurgical ways to resolve the prolapse in the literature, but the results are difficult to interpret due to the wide variety of patient population and surgical techniques used for analysis. This study aims to prospectively evaluate the impact of surgery on the improvement of OAB symptoms in a homogenous cohort of patients who underwent vaginal hysterectomy and anterior colporrhaphy for advanced stage POP.

METHODOLOGY:

This is a prospective observational study involving patients with OAB who underwent vaginal hysterectomy and anterior colporrhaphy for advanced-stage POP in a Philippine tertiary referral center for a 1 year period. Objective change in OAB symptom bother was measured using a 3-day bladder diary and an office cystometry, while subjective change in the quality of life was measured through the OAB-Validated 8-question Awareness Tool (OAB V-8) done before and 6 weeks after surgery.

RESULTS:

A total of 43 patients undergoing vaginal hysterectomy, McCall culdoplasty, anterior and posterior colporraphy ± bilateral iliococcygeal fixation were included for analysis. Ninety-three percent ( n = 40) of the participants were defined to have “improved” OAB symptoms, and none of the patients had “persistent” OAB symptoms. A statistically significant decrease in the degree of OAB symptom bother is noted based on a decrease of baseline OAB-V8 score from 20.47 ± 6.70 to 5.09 ± 4.06 6 weeks after surgery. There is also a statistically significant decrease in the average number of daytime voiding episodes and an increase in the average volume per void compared to baseline levels as noted in the 3-day diary. In the filling cystometry, there was an observed increase in the cystometric volumes of the first, strong, and maximum urge sensations, which were also all found to be statistically significant when compared to baseline values, with no patient developing urinary retention and de novo stress urinary incontinence 6 weeks after surgery.

CONCLUSION:

This study proves that patients suffering from both advanced-stage POP and OAB experience significant resolution of OAB symptoms after vaginal hysterectomy and anterior colporrhaphy. This information can be utilized in counseling patients regarding the high likelihood of OAB symptom resolution following prolapse repair.

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