Pelvic floor disorders are pervasive, with over 1 in 3 women reporting at least one pelvic floor disorder in their lifetime1. Many seek surgical treatment, yet pelvic floor surgeries can have unintended consequences. For example, approximately 10-20% of women develop overactive bladder (OAB) following pelvic floor surgery2,3. Prior investigations of de novo OAB following pelvic floor surgery include relatively young and healthy women and thus may not accurately represent the risk posed to older women. This study aimed to determine the incidence of de novo OAB and describe OAB treatment use among older women following pelvic floor surgery.

This retrospective cohort study involved a 100% sample of fee-for-service Medicare beneficiaries who underwent pelvic floor surgery [for pelvic organ prolapse (POP) and/or stress urinary incontinence] from 2015-2020. The primary outcome was a new diagnosis of OAB within 2 years of surgery, defined by International Classification of Diseases codes and/or a new OAB medication prescription. The secondary outcome was OAB treatment—medication or minimally invasive therapy—identified by Current Procedural Terminology and National Drug Codes, respectively. Demographic and clinical characteristics were stratified by type of pelvic floor surgery (POP, urethral sling, urethral bulking). Modified Poisson regression models were used to calculate the relative risk (RR) of the outcomes.

Among the 57,346 beneficiaries who underwent pelvic floor surgery, 25,733 (44.9%) had a new diagnosis of OAB within 2 years. Compared to POP repair with concomitant urethral sling, isolated urethral sling (aRR 1.6, 95%CI 1.6-1.7), POP surgery alone (aRR 1.8, 95%CI 1.8-1.9), and urethral bulking (aRR 1.9, 95%CI 1.9-2.0) were associated with increased risk of de novo OAB. Older age (age≥75 aRR 1.1, 95%CI 1.1-1.1, compared to 65-74) and increased frailty (mildly to severely frail aRR 1.4, 95%CI 1.4-1.5, compared to not frail) were also associated with an increased risk of de novo OAB. Among the entire cohort who underwent pelvic floor surgery, 13.9% (N=7,976) received new OAB treatment within 2 years of surgery (Table). Pharmacotherapy was the most common treatment across all surgery types (N=6,393, 11.1%), and among those who had minimally invasive therapy (N=1,583, 2.8%), onabotulinumtoxinA was most common (N=772/1,583, 48.8%). Increased frailty was associated with an increased likelihood of receiving OAB treatment (mildly to severely frail aRR 2.0, 95%CI 1.8-2.1, compared to not frail).

In this national study of Medicare beneficiaries who underwent pelvic floor surgery, nearly half developed OAB within 2 years of surgery. POP surgery with a concomitant urethral sling resulted in the lowest incidence of de novo OAB. Despite the significant disease burden associated with OAB in older women, only 1 in 3 beneficiaries with de novo OAB initiated treatment within 2 years of surgery, the majority of which was pharmacotherapy. These findings are notable given that this cohort represents a group of women with established specialty or subspeciality-level pelvic floor care, a setting in which diagnosis and management of OAB would be expected. Thus, the low rates of treatment may be due to transient or mild severity of symptoms among those who develop OAB following pelvic floor surgery.

Approximately 1 in 2 women developed OAB within 2 years of pelvic floor surgery. Despite this high incidence, few initiated treatment, and minimally invasive therapy use was uncommon. Future work is needed to better understand whether de novo OAB following pelvic floor surgery is transient, associated with mild symptoms, or undertreated in older women so that we can better serve this large cohort of women.

Kenne KA, Wendt L, Brooks Jackson J. Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors. Sci Rep. 2022;12(1):9878. doi:10.1038/s41598-022-13501-w
Burgio KL, Nygaard IE, Richter HE, et al. Bladder symptoms 1 year after abdominal sacrocolpopexy with and without Burch colposuspension in women without preoperative stress incontinence symptoms. Am J Obstet Gynecol. 2007;197(6):647.e1-6. doi:10.1016/j.ajog.2007.08.048
Marcelissen T, Van Kerrebroeck P. Overactive bladder symptoms after midurethral sling surgery in women: Risk factors and management. Neurourol Urodyn. 2018;37(1):83-88. doi:10.1002/nau.23328

Continence 19S (2026) 102686
DOI: 10.1016/j.cont.2026.102686