The number of factors for metabolic syndrome is the risk factor for de novo OAB after pelvic organ prolapse repair

Kataoka M1, Honda R1, Onagi A1, Tanji R1, Matsuoka K1, Hoshi S1, Koguchi T1, Hata J1, Satoh Y1, Akaihata H1, Ogawa S1, Haga N1, Kojima Y1

Research Type

Clinical

Abstract Category

Overactive Bladder

Abstract 582
E-Poster 3
Scientific Open Discussion Session 31
Friday 6th September 2019
13:45 - 13:50 (ePoster Station 3)
Exhibition Hall
Overactive Bladder Urgency Urinary Incontinence Pelvic Organ Prolapse Surgery
1.Fukushima medical university school of medicine
Presenter
M

Masao Kataoka

Links

Poster

Abstract

Hypothesis / aims of study
The de novo OAB after pelvic organ prolapse (POP) repair not only lowers the patient's QOL, but also requires a therapeutic agent and a urine absorption pad, resulting in an economic burden.In addition, the onset mechanism is still unclear and there is no preventive method yet. In this study, we examined the risk factors of de novo OAB after POP repair, and considered the elucidation of its onset mechanism and preventive methods.
Study design, materials and methods
A total of 106 patients with POP who underwent POP repair in our hospital were included and retrospectively analyzed. Patients with preoperative OAB, with previous POP surgery or anti incontinence surgery, active urinary infections, bladder tumor or stones were excluded. All patients were performed reinforcement of the anterior vaginal wall using a mesh. In patients with uterine prolapse and large rectcele, mesh was also placed on the posterior vaginal wall. Urologic and gynecologic history, vaginal examination and overactive bladder symptom score (OABSS) were completed all patients. We diagnosed OAB with 2 or more urgency scores and 3 or more total scores . POP was evaluated at pelvic organ prolapse quantification (POP-Q). The presence or absence of paravaginal defect was evaluated by MRI examination while inducing Valsalva. We diagnosed paravaginal defect that the attachment of the vagina to the pelvic sidewalls was removed. Prior to surgery, urodynamics study examination (UDS), urethral pressure profiles (UPP) or abdominal leak point pressure (ALPP) was performed in all cases. The urethral function was evaluated by Q-tip test and stress test with 200 ml of physiological saline injected into the bladder of the patient. The stress test was performed by injecting 200 - 300 ml of saline into the bladder. Postoperative OAB symptoms were obtained by OABSS 12months after operation and mean follow up periods was 42.7 months. We defined improvement of OAB as either complete resolution of frequency and/or urge incontinence, or improvement (decrease urgency score less than 2 and total score less than 3). They were divided into clinically preoperative OAB group (n=47) and non OAB group (n=59). Factors correlated with de novo OAB after POP repair surgery were examined to elucidate the cause of OAB onset in POP patients.
Results
Of the 59 cases who did not have OAB before surgery, de novo OAB was found in 5 cases (8.4%). There were significant correlation between de novo OAB and metabolic syndrome (Mets) factors (hypertension: p = 0.01, diabetes, BMI, METs2 factor, METs3 factor: p <0.01). In addition, METs factor 3 possession was a strong risk factor (OR 79.5, p <0.001, 95% CI 5.5-1145.1). As a result of histological examination, arteriosclerotic change of the small bladder arteriole was significantly enhanced in the METs group (p <0.01). Furthermore, it was confirmed that in the bladder, sympathetic nerves are more distributed on the dorsal side than the ventral side of the bladder.
Interpretation of results
The number of factors for metabolic syndrome was correlated to de novo OAB after pelvic organ prolapse repair. In the Mets group, arteriolosclerosis of the bladder was significantly progressed. Arteriolosclerosis of the bladder is thought to cause bladder ischemia and damage the bladder mucosa and nerves.The dorsal side of the bladder is a site that is abraded, sutured, etc. by pelvic organ prolapse repair, which is considered to be susceptible to surgical damage. It is thought that ischemic changes in the bladder and surgical damage cause de novo OAB after pelvic organ prolapse repair.
Concluding message
Metabolic syndrome factors have been suggested to be the cause of de novo OAB after pelvic organ prolapse repair. It seems that there is a possibility of preventing de novo OAB after POP repair surgery by proactively intervention of treatment for metabolic syndrome.
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Disclosures
Funding The authors declare no conflicts of interest associated with this manuscript. Clinical Trial No Subjects Human Ethics Committee Fukushima Medical University Ethics Committee Helsinki Yes Informed Consent Yes
27/03/2024 15:49:09