Pelvic organ prolapse (POP) is a common condition in women, often accompanied by urinary urgency, which may persist even after successful surgical repair. Persistent post-operative urgency (PPOU) poses a significant clinical challenge, impacting quality of life. The American Urogynecologic Society (AUGS) stresses the need for a thorough evaluation and counseling for POP patients, focusing on urinary symptoms and the risk of persistent symptoms after surgery. Detrusor overactivity (DO), marked by involuntary detrusor muscle contractions on urodynamic study (UDS), has been identified as a risk factor for PPOU3. While several urodynamic parameters and DO characteristics have been shown to predict PPOU in male patients with lower urinary tract symptoms undergoing prostatectomy, no study has assessed this topic in women treated with POP surgery so far. This study aims to investigate whether preoperative UDS parameters and DO characteristics can predict PPOU 12 months after vaginal native tissue repair (NTR) for advanced POP.

Following IRB approval, we collected data using the hospital's electronic medical records of all patients who underwent POP between January 2013 and December 2024 and had preoperative urgency. We included women who underwent preoperative UDS; whose surgery included hysterectomy, anterior colporrhaphy, and sacrospinous ligament fixation (SSLF); and who returned for postoperative follow-up at 12 months. Data on demographics, background morbidity, preoperative and postoperative pelvic floor symptoms, pre- and postoperative POP-Q measurements were collected from clinical files. Data on UDS parameters and DO characteristics were obtained from the analysis of pressure-flow study tracings from the Aquarius LT (LABORIE MEDICAL TECHNOLOGIES CORP., Pease International Tradeport, 180 International Drive, Portsmouth, NH 03801 USA) urodynamic records database. Women with PPOU and those without PPOU were compared.

Sixty-one women were included in the analysis. Upon comparison of the two groups, we identified no difference in demographic parameters, background morbidity and POP-Q measurements (table 1). Forty women presented with PPOU and 21 had postoperative urgency resolution. The only statistically significant difference we found between groups was a significantly lower bladder capacity in the PPOU group as compared to the urgency resolution group (408 ml vs 416 ml respectively, P=0.04). No significant difference was observed in all other DO characteristics.

The study results indicate that a lower bladder capacity on UDS is significantly associated with the occurrence of PPOU in women following NTR for advanced POP. We also explored the role of several additional UDS parameters, with special focus on DO characteristics such as timing or intensity of the DO contractions and found no association between the latter and PPOU. The correlation we observed between PPOU, and bladder capacity suggests this parameter may serve as a critical predictor for PPOU

These findings highlight the importance of comprehensive preoperative assessments in women undergoing POP surgery. Recognizing reduced bladder capacity as a predictive factor for PPOU can enhance preoperative counseling, allowing healthcare providers to set realistic expectations of surgery and improve patient satisfaction and decision making.

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Padoa A, Levy E, Fligelman T, Tomashev-Dinkovich R, Tsviban A, Serati M. Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse. Int Urogynecology J. 2023;34(3):759-767. doi:10.1007/s00192-022-05313-3
Creta M, Collà Ruvolo C, Longo N, et al. Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol. 2021;73(1):59-71. doi:10.23736/S2724-6051.20.03678-4