(Poster 110) OAB Symptoms Improve Following Treatment of Pelvic Organ Prolapse

Objectives: Assess the association of pelvic organ prolapse (POP) treatment and overactive bladder (OAB) symptoms.

Methods: We performed a retrospective cohort study of patients in an academic urogynecology practice. Patients were included if they were at least 18 years old and presenting for evaluation of OAB symptoms from January 2022 to December 2022. Among this cohort, we identified patients who had POP beyond the hymen. We also identified those among the cohort who ultimately underwent treatment of POP with either surgery or a pessary. We collected baseline characteristics, medical and surgical history, baseline and postoperative Pelvic Floor Distress Inventory-20 (PFDI-20) scores and assessment of OAB symptom improvement collected at the postoperative visit (3 months following surgery) or at the most recent follow up visit following treatment. Differences in patient characteristics and outcomes between those who underwent POP treatment and those who did not were described using chi-square and t-tests where appropriate. Multivariable logistic regression analyses were performed to determine if treatment for prolapse (pessary or surgery) is associated with significant improvement in OAB symptoms, controlling for Urinary Distress Inventory-6 (UDI-6) score, post-void residual (PVR), OAB treatment initiation, and SUI treatment. Significant improvement was defined as an answer of “very improved” or “completely improved” on follow up OAB symptom assessment.

Results: The cohort included 146 patients. The average age was 67 years (standard deviation ±12.4), and most patients were white (76.0%). Most women were postmenopausal (55.6%). Of the 146 patients, 129 (88.4%) had treatment for prolapse (49 (33.6%) with pessary and 80 (54.8%) with surgery), and 68 (46.6%) had treatment for SUI (1 (0.7%) with pessary and 67 (45.9%) with midurethral sling). After the initial appointment, 79 (54.1%) patients started OAB treatment. Patients who underwent treatment of prolapse were more likely to also undergo treatment of SUI (50.4% vs 17.6%, p=0.039). Other baseline characteristics did not differ between groups. Patients who had treatment of prolapse were more likely to report any OAB symptom improvement and were more likely to have significant improvement in OAB symptoms (Table 1). Controlling for age, baseline UDI-6 score, baseline PVR, SUI treatment and OAB treatment in a multivariable logistic regression model, prolapse treatment with surgery was associated with higher odds of significant improvement in OAB symptoms (aOR 7.7 (95% CI 1.8-39.4), Table 2). Pessary treatment for POP was not associated with significant improvement in OAB symptoms.

Conclusions: In patients with bothersome OAB who also have POP, those who underwent surgical correction of their POP have a higher likelihood of significant OAB symptom improvement compared to those who do not have surgical treatment for POP, independent of concomitant anti-incontinence procedures and therapies.