The influence of mesh pelvic floor reconstructive surgery on OAB symptoms

Objectives: The working hypothesis was that pelvic organs prolapse can induce overactive bladder symptoms. Therefore, restoration of pelvic anatomy with accompanying proper urodynamic parameters (cystometric volume, micturition volume, uroflow) should resolve OAB (Overactive Bladder) symptoms. Materials and methods: Forty eight women, aged 51-77 years (mean 62.4 +/- 7.32), with stage II, III or IV prolapse (POP-Q scale) were included into the study. Patients with LUTS (Lower Urinary Tract Symtoms - inflammation, infection, pain) were excluded. Each patient underwent clinical evaluation and full urodynamic examination (cystometry and uroflowmetry, MMS Libra +). Depending on the type of the anatomical defect on the POP-Q scale - anterior defect, posterior defect or both anterior and posterior - a repair using polypropylene monofilament mesh was performed (TVM anterior, TVM posterior or TVM Total). Patients were asked to complete King's Health questionnaire before and after the reconstructive surgery. Statistical analysis was performed using Kolmogorov-Smirnov and U Mann-Whitney tests. Results: Overactive bladder symptoms were diagnosed in 27 patients. Detrusor overactivity was found in 10 patients. In 17 patients, out of 27 with OAB before surgery, overactivity symptoms completely resolved after the surgery (63%). On the other hand, post-op de novo OAB symptoms appeared in 2 patients (4.1%). Half of the patients with OAB symptoms after surgery had detrusor overactivity before mesh repair while only 30% of patients without OAB symptoms after surgery had DO (Detrusor Overactivity) before the surgical procedure. Micturition volume in group of patients with OAB significantly increased after the surgery (293.78 ml vs. 364.15 ml; p=0.006). Maximal cystometric capacity in patients with overactive bladder also significantly increased after the surgery (318.78ml vs. 407ml; p=0.0001). Quality of life measured by King's questionnaire improved in the group of patients with resolution of OAB symptoms in such domains as: Incontinence Impact, Role Limitations and Sleep/emotions, p<0.05. Conclusions: Correction of pelvic organ prolapse stage II, III and IV in patients with OAB symptoms leads to an improvement in bladder conditions in half of the patients. Such treatment also resulted in symptom resolution of detrusor overactivity ascertained in urodynamic studies. Overactive bladder syndrome with DO was more resistant to surgical treatment as compared to OAB without DO. Quality of life improved in patients who did not present with OAB bladder symptoms after the mesh surgery. Restoration of proper anatomy might also cure or improve bladder symptoms in patients with OAB symptoms, coexisting with advanced pelvic organ prolapse.