Top

International Urogynecology Journal

Published in:

01-07-2019 | Original Article

What happens to urinary incontinence after pelvic organ prolapse surgery?

Authors: Aiste Ugianskiene, Niels Kjærgaard, Thomas Larsen, Karin Glavind

Published in: International Urogynecology Journal | Issue 7/2019

Abstract

Introduction and hypothesis

The beneficial effect of pelvic organ prolapse (POP) surgery on urge urinary incontinence (UI) is well described in the literature, while effect on preoperative stress UI (SUI) is still unclear. The aim of this study was to investigate changes concerning UUI following POP surgery without concomitant anti-incontinence procedures and to identify possible factors influencing the changes.

Methods

We conducted a retrospective study of 678 women with prolapse surgery using native tissue repair during a 3-year period. Patients completed three prolapse questions from the International Consultation on Incontinence–Vaginal Symptoms (ICIQ-VS) questionnaire and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who scored >0 on the ICIQ-UI SF before surgery were included in the study.

Results

A total of 379 patients (55.9%) with POP had concomitant UI. At 3 months’ follow-up, 174 patients (46%) became continent compared with 205 patients (54%) with UI. Patients with remaining UI had statistically significant higher mean preoperative ICIQ-UI SF score than patients who became dry. The risk of remaining UI after POP surgery was greater in patients with previous anti-incontinence repair. UI type was not a risk factor for its persistance.

Conclusion

Almost half of the patients with UI before POP surgery became completely dry after prolapse surgery alone. Severity of incontinence and previous anti-incontinence surgery were identified as risk factors for persisting UI after POP surgery. We found a reduction of incontinence after an operation in any of the three compartments.

Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305.CrossRefPubMed

Almousa S, Bandin van Loon A. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: a systematic review. Maturitas. 2018;107:78–83.CrossRefPubMed

Bump RC, Fantl JA, Hurt WG. The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. Obstet Gynecol. 1988;72(3 Pt 1):291–5.PubMed

Lensen EJ, Withagen MI, Kluivers KB, Milani AL, Vierhout ME. Urinary incontinence after surgery for pelvic organ prolapse. Neurourol Urodyn. 2013;32(5):455–9.CrossRefPubMed

Bai SW, Jeon MJ, Kim JY, Chung KA, Kim SK, Park KH. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(4):256–60.CrossRefPubMed

Ramanah R, Ballester M, Chereau E, Rouzier R, Daraï E. Effects of pelvic organ prolapse repair on urinary symptoms: a comparative study between the laparoscopic and vaginal approach. Neurourol Urodyn. 2012;31(1):126–31.CrossRefPubMed

Digesu GA, Salvatore S, Chaliha C, et al. Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1439–43.CrossRefPubMed

Fletcher SG, Haverkorn RM, Yan J, et al. Demographic and urodynamic factors associated with persistent OAB after anterior compartment prolapse repair. Neurourol Urodyn. 2010;29:1414–8.CrossRefPubMed

Foster RTS, Barber MD, Parasio MF, et al. A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007;197(82):e1–4.

10.

de Boer TA, Salvatore S, Cardozo L, et al. Pelvic organ prolapse and overactive badder. Neurourol Urodyn. 2010;29:30–9.CrossRefPubMed

11.

de Boer TA, Kluivers KB, Withagen MI, Milani AL, Vierhout ME. Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery. Int Urogynecol J. 2010;21(9):1143–9.CrossRefPubMedPubMedCentral

12.

Nguyen JK, Bahatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166:2263–6.CrossRefPubMed

13.

Miranne JM, Lopes V, Carberry CL, Sung VW. The effect of pelvic organ prolapse severity on improvement in overactive bladder symptoms after pelvic reconstructive surgery. Int Urogynecol J. 2013;24(8):1303–8.CrossRefPubMed

14.

Kim MS, Lee GH, Na ED, Jang JH, Kim HC. The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse. Obstet Gynecol Sci. 2016;59(3):214–9.CrossRefPubMedPubMedCentral

15.

Costantini E, Lazzeri M, Zucchi A, Mearini L, Fragalà E, Del Zingaro M, et al. Urgency, detrusor overactivity and posterior vault prolapse in women who underwent pelvic organ prolapse repair. Urol Int. 2013;90(2):168–73.CrossRefPubMed

16.

Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. Pelvic floor disorders network. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67.CrossRefPubMedPubMedCentral

17.

Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, et al. Pelvic floor disorders network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66.CrossRefPubMed

18.

Liapis A, Bakas P, Georgantopoulou C, Creatsas G. The use of the pessary test in preoperative assessment of women with severe genital prolapse. Eur J Obstet Gynecol Reprod Biol. 2011;155(1):110–3.CrossRefPubMed

19.

van der Ploeg JM, van der Steen A, Oude Rengerink K, van der Vaart CH, Roovers JP. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomized trials. BJOG. 2014;121(5):537–47.CrossRefPubMed

20.

Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function. Int Urogynecol J. 2013;24(11):1843–52.CrossRefPubMed

21.

Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanssen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J. 2010;21(2):179–86.CrossRefPubMed

22.

Ennemoser S, Schönfeld M, von Bodungen V, Dian D, Friese K, Jundt K. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J. 2012;23(7):851–855.

23.

Jundt K, Wagner S, von Bodungen V, Friese K, Peschers UM. Occult incontinence in women with pelvic organ prolapse - does it matter? Eur J Med Res. 2010;15(3):112.CrossRefPubMedPubMedCentral

24.

Guldberg R, Brostrøm S, Hansen JK, Kærlev L, Gradel KO, Nørgård BM, et al. The Danish Urogynecological database: establishment, completeness and validity. Int Urogynecol J. 2013;24:983–90.CrossRefPubMed

25.

Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(4):655–84.CrossRefPubMed

26.

Price N, Jackson SR, Avery K, Brookes ST, Abrams P. Development and psychometric evaluation of the ICIQ vaginal symptoms questionnaire: the ICIQ-VS. BJOG. 2006;113(6):700–12.CrossRefPubMed

27.

Abrams P, Avery K, Gardener N, Donovan J. ICIQ advisory board. The international consultation on incontinence modular questionnaire: www.iciq.net. J Urol. 2006;175:1063–6.CrossRefPubMed

28.

Brading AF. A myogenic basis for the overactive bladder. Urology. 1997;50(6A Suppl):57–67. discussion 68-73CrossRefPubMed

29.

Ugianskiene A, Kjærgaard N, Inger Lindquist AS, Larsen T, Glavind K. Retrospective study on de novo postoperative urinary incontinence after pelvic organ prolapse surgery. Eur J Obstet Gynecol Reprod Biol. 2017;219:10–4.CrossRefPubMed

30.

King AB, Goldman HB. Stress incontinence surgery at the time of prolapse surgery: mandatory or forbidden? World J Urol. 2015;33:1257–62.CrossRefPubMed

Title: What happens to urinary incontinence after pelvic organ prolapse surgery?
Authors: Aiste Ugianskiene
Niels Kjærgaard
Thomas Larsen
Karin Glavind
Publication date: 01-07-2019
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 7/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3677-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

What happens to urinary incontinence after pelvic organ prolapse surgery?

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2019

Methodological approaches to botulinum toxin for the treatment of chronic pelvic pain, vaginismus, and vulvar pain disorders

Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies

Validation of the Chinese version of the Pelvic Floor Distress Inventory-20 (PFDI-20) according to the COSMIN checklist

Validation of the Turkish version of the International Consultation on Incontinence Questionnaire-vaginal symptoms (ICIQ-VS)

Laparoscopic management of a large urethral leiomyoma

In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women