Surgical Treatment of Pelvic Organ Prolapse and Overactive Bladder: A Systematic Review and Meta‐Analysis
Lorenzo Vacca, Daniela Caramazza, Michele Pierro, Aniello Foresta, Andrea Lombisani, Anna Fagotti, Alfredo Ercoli, Giuseppe CampagnaABSTRACT
Background
Pelvic organ prolapse (POP) frequently coexists with overactive bladder (OAB) symptoms, yet the impact of surgical correction on OAB outcomes remains incompletely characterized across different surgical approaches.
Objectives
To quantify OAB symptom resolution rates following POP surgery, compare outcomes across surgical techniques, evaluate de novo OAB incidence, and identify predictive factors for postoperative OAB persistence or development.
Search Strategy
Comprehensive search of MEDLINE, Embase, Web of Science, Scopus, Cochrane CENTRAL,
Selection Criteria
Comparative studies (randomized controlled trials and observational studies) including adult women with symptomatic POP (POP‐Q stage ≥II) undergoing surgical correction, reporting validated OAB outcomes with minimum 3‐month follow‐up.
Data Collection and Analysis
Three independent reviewers extracted data using predefined criteria. Random‐effects meta‐analyses with Freeman‐Tukey double arcsine transformation were performed. Quality assessment employed Cochrane Risk of Bias 2.0, Newcastle‐Ottawa Scale, and GRADE methodology.
Main Results
Twenty‐four studies encompassing 7739 women (7095 analyzed) were included. Overall OAB resolution rate was 58.0% (95% CI: 55.9%–60.1%; I 2 = 83.9%). No significant differences emerged between vaginal, laparoscopic/robotic, or abdominal approaches ( p = 0.62), or between mesh‐augmented versus native tissue repairs ( p = 0.48). Compartment‐specific analysis revealed anterior/apical repairs achieved significantly higher resolution (75.8%, 95% CI: 73.2%–78.3%) compared to isolated posterior repairs (28.3%, 95% CI: 20.1%–37.9%; p < 0.001). De novo OAB incidence ranged 0%–14.3%, though reporting was limited to 6 studies.
Conclusions
POP surgery resolves preexisting OAB in approximately three‐fifths of patients, with anatomical compartment representing the strongest predictor. Anterior/apical prolapse correction offers superior OAB outcomes compared to posterior repair, independent of surgical approach or mesh utilization.