Minimally Invasive Overactive Bladder Therapy After Prolapse Surgery

Associations between pelvic organ prolapse and overactive bladder exist, yet little is known regarding minimally invasive overactive bladder therapy use among older women following prolapse surgery.

The aim of the study was to determine minimally invasive overactive bladder therapy use (onabotulinumtoxinA injection, percutaneous tibial nerve stimulation, sacral neuromodulation) in older women following prolapse surgery.

This was a retrospective cohort study of a 100% sample of fee-for-service Medicare beneficiaries who had prolapse surgery 2014-2015. The primary outcome was new minimally invasive overactive bladder therapy and the secondary outcome was new overactive bladder diagnosis within Medicare claims data, within 2 years of prolapse surgery. Data were stratified by surgery type (obliterative, apical, anterior/posterior, and apical with anterior/posterior). Modified Poisson regression models were used to calculate relative risk for each outcome.

Among the 58,841 beneficiaries who underwent prolapse surgery, 1,120 (1.9%) received minimally invasive overactive bladder therapy within 2 years. Among those who underwent prolapse surgery and did not have a preexisting diagnosis of overactive bladder, 9.2% (2,580/28,160) had a new overactive bladder diagnosis within 2 years. Factors associated with the increased adjusted relative risk (aRR) of new minimally invasive overactive bladder therapy included surgery type (apical aRR 1.6, 95% CI, 1.2-2.2 compared to obliterative repair), concomitant stress urinary incontinence surgery (aRR 1.3, 95% CI, 1.2-1.5), preexisting overactive bladder (aRR 4.1, 95% CI, 3.4-4.8), and frailty (mild to severe frailty aRR 3.4, 95% CI, 2.7-4.3 compared to not frail).

Rates of minimally invasive overactive bladder therapy following prolapse surgery were low in a national cohort of female Medicare beneficiaries despite a high prevalence of disease.