Urge Incontinence After Pelvic Organ Prolapse Surgery: A Secondary Analysis

Patients with pelvic organ prolapse (POP) are 6 times more likely to experience overactive bladder and/or urgency urinary incontinence (UUI). Given the high prevalence of concomitant urinary symptoms, evaluating the effect of surgical prolapse repair on urinary urgency is critical for surgical counseling.

The objective of this study was to evaluate changes in UUI symptoms in women after performance of apical and/or anterior wall repair for the management of POP.

This secondary analysis included all women participating in the SUPeR, OPTIMAL, and OPUS trials. The primary outcome of urge incontinence symptoms was evaluated with the Pelvic Floor Distress Inventory (PFDI). Pelvic Organ Prolapse Quantification (POP-Q) measurements were evaluated at baseline and 12 months postoperatively. The secondary outcome of overall urinary function was assessed using the Urogenital Distress Inventory-6 (UDI-6) subscore of the Pelvic Floor Distress Innventory (PFDI) and Urinary Impact Questionnaire-7 (UIQ-7) subscore of the Pelvic Floor Impact Questionnaire (PFIQ).

Seven hundred thirty-five women were included for analysis, of which 82.3% of the cohort underwent a native tissue repair, 13.6% a mesh-augmented hysteropexy, 69.1% an anterior repair (AR), and 68.8% a midurethral sling (MUS). Postoperative improvement in UUI and bladder emptying was demonstrated across the cohort, with greater improvements in UDI-6 and UIQ-7 subscores among women with pre-existing UUI ( P <0.001). Greatest improvement was seen for the combination of either uterosacral ligament suspension or sacrospinous ligament fixation with AR and concomitant MUS placement. Undergoing MUS placement (with or without AR) resulted in greater improvement in UDI-6 and UIQ-7 subscores than undergoing an AR alone ( P <0.001).

POP surgery improves UUI with the greatest improvements in women undergoing native tissue repair with AR and concomitant MUS placement.