Overactive Bladder Symptoms Following Apical Prolapse Repair With or Without Midurethral Sling

Data are limited regarding the impact of concomitant midurethral sling (MUS) placement at the time of apical pelvic organ prolapse repair (POPR) on postoperative changes in overactive bladder and urge urinary incontinence (OAB/UUI). This study is aimed at comparing OAB/UUI outcomes in women following POPR with versus without MUS.

This is a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent vaginal apical native tissue repair, sacrocolpopexy, or colpocleisis. All patients had baseline OAB/UUI or mixed urinary incontinence; outcomes of those who did and those did not undergo MUS were assessed using validated questionnaires. OAB/UUI outcomes were classified as improved/resolved or persistent.

A total of 167 participants met the inclusion criteria, 59 underwent MUS placement, and 108 did not. There was no significant difference between cohorts regarding persistence of OAB/UUI at 12 months. Persistent OAB/UUI was present in 8 patients with MUS (13.6%) versus 15 without MUS (13.9%; p > 0.9). There was no difference in new postoperative treatment for OAB/UUI between cohorts (p > 0.9) and there was no difference in measures of bother associated with urinary frequency and UUI between cohorts postoperatively. Participants who underwent MUS or had improved/resolved OAB/UUI were more likely to report global improvement of their bladder function after surgery.

In women undergoing apical POPR, OAB/UUI symptoms often improved or resolved, regardless of concomitant MUS placement. However, women who had a concomitant MUS were more likely to report improvement in patient-reported outcomes.