Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women

Area of Science:

• Urology
• Gynecology
• Women's Health

Background:

• Overactive bladder (OAB) significantly impacts women's quality of life.
• Urinary incontinence (UI) surgical interventions are common treatments for OAB symptoms.
• Long-term efficacy of these surgeries on OAB symptom resolution requires further investigation.

Purpose of the Study:

• To evaluate the changes in overactive bladder (OAB) symptoms up to five years post-surgery.
• To identify predictors of symptom change from baseline after UI surgery.
• To compare the effectiveness of different surgical procedures for stress-predominant mixed UI on OAB symptoms.

Main Methods:

• Secondary analysis of three multicenter UI surgical trials involving women with stress-predominant mixed UI.
• Participants underwent Burch colposuspension, autologous fascial sling, or midurethral slings (retropubic or transobturator).
• Primary outcome: >=70% improvement in Urinary Distress Inventory-Irritative subscale scores; analyzed using generalized linear models up to 5 years.

Main Results:

• All surgical groups showed significant improvement in OAB symptoms at 1 year (P<.001), with 50-71% of women reporting improvement.
• Improvements between midurethral sling groups were similar at 1 year and persisted over 5 years.
• Burch colposuspension showed greater OAB symptom improvement compared to pubovaginal sling at 1 year, a difference maintained over 5 years.
• The proportion of patients with >=70% UI improvement decreased from 50.0-64.3% at 1 year to 36.5-54.1% at 5 years (P<.001).
• Preoperative anticholinergic use and urodynamic parameters did not predict OAB symptom change.

Conclusions:

• Most women experience significant OAB symptom improvement after incontinence surgery, though this diminishes over time.
• Obesity was identified as a factor that blunts symptom improvement following surgery.
• Surgical interventions for UI provide initial OAB symptom relief, but long-term durability varies and is influenced by factors like obesity.