To examine the prevalence of overactive bladder (OAB) in women with pelvic organ prolapse (POP) and its improvement with mesh surgery.

We retrospectively reviewed 226 patients who underwent mesh surgery for POP, of whom Overactive Bladder Symptom Score (OABSS) could be confirmed pre-and post-operatively. OAB was determined by OABSS (patients with a Q3 score of 2 or more and a total score of 3 or more). The degree of bother was assessed with the 100mm-VAS scale (OABSS-VAS). The persistent urgency was defined as postoperative OABSS-Q3≥1.

The median age was 72.5 (range 42-87) years, BMI was 24 (14-39), the number of parities was 2 (0-5), and 22% of patients had a history of hysterectomy. Regarding the POP site, patients with POP ≥ POP-Q stage3 was 87% for anterior prolapse, 38% for apical prolapse, and 11% for posterior prolapse. Median(range) OABSS scores were 1 (0-2) for Q1, 1 (0-3) for Q2, 2 (0-5) for Q3, and 1 (0-5) for Q4, for a total score of 6 (0-14). Median(range) OABSS-VAS-QOL score was 73 (0-100). 117 patients underwent TVM, while 109 patients underwent laparoscopic/robotic SC. 118 patients (52%) had preoperative OAB. Postoperative OABSS and OABSS-VAS (bother) were all significantly improved (p<0.0001). Of the patients with preoperative OAB, resolution of urgency was observed in 75(64%) of patients.  In the comparison between patients with or without persistent urgency, there were no significant differences in age, BMI, POP compartment (anterior, apical, or posterior), comorbidities (hypertension, Diabetes mellitus, neurological disease), or surgical procedure. However, preoperative OABSS-Q3 (median 4 (2-5) vs 3 (2-5), p<0.0001), Q4 (3 (1-5) vs 2 (0-5), p=0.001), OABSS total score (10 (4-13) vs 8 (4-14, p<0.0001) , and OABSS-Q3-VAS (79(5-100) vs 72(0-100) p=0.02) were significantly higher in the patients with persistent urgency.

In our cohort of women with advanced POP, 52% of the patients had OAB. We observed postoperative resolution of urgency in 64% of subjects, which is similar to previous reports (Padoa et al., Int Urogynecol J. 2023, Long C. et al., Int Urogynecol J. 2011). It appeared that patient characteristics such as age and BMI, comorbidities, or surgical procedures did not influence the risk of persistent urgency after mesh surgery. Severe preoperative OAB symptoms and bother correlated with the persistent postoperative urgency as previously reported (de Boer et al., Int Urogynecol J. 2010).

OAB was found in 52% of patients with POP. Urgency persisted in 36% of patients after mesh surgery for POP. Persistent OAB may likely occur in patients with severe OAB symptom preoperatively.

Padoa, Anna, et al. "Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse." International Urogynecology Journal 34.3 (2023): 759-767.
Long, Cheng-Yu, et al. "Predictors of improved overactive bladder symptoms after transvaginal mesh repair for the treatment of pelvic organ prolapse: predictors of improved OAB after POP repair." International urogynecology journal 22 (2011): 535-542.
de Boer, Tiny A., et al. "Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery." International urogynecology journal 21 (2010): 1143-1149.