Introduction: We investigated the relationship between posterior vault prolapse and overactive bladder (OAB) symptoms or detrusor overactivity (DO) and their changes after surgical repair. Methods: Forty-three patients with vault prolapse and prevalent posterior compartment prolapse -underwent pelvic organ prolapse repair surgery: 28 received colposacropexy and 15 were treated by the vaginal approach. Subjective success was lack of prolapse-related symptoms or urgency. OAB symptoms, voiding symptoms and constipation were evaluated. Patient satisfaction was defined by a visual analog scale score (range 0-10). Objective anatomical success was defined as no vaginal prolapse of stage ≥2 at any vaginal site. Results: The median follow-up was 75 months (range 24-143). Preoperatively, 33/43 patients (76.74%) reported urgency. DO was found in 11/43 patients (25.6%), and 22/43 patients reported constipation. The anatomical outcome showed 2 persistent stage II rectoceles (6.9%). After surgery, OAB symptoms disappeared in 25/33 (75.88%) and persisted in 8 patients (24.2%); there was no de novo urgency. DO disappeared in 8/11 subjects (72.7%). Preoperative constipation was present in 17/33 patients with OAB symptoms (51.5%) and disappeared postoperatively in 13/17 patients (76.4%) (p < 0.013). De novo constipation appeared in 3 patients (associated with OAB in 2 patients). Conclusions: Prevalent posterior compartment pelvic organ prolapse and OAB/DO were often associated. After surgery, OAB symptoms and DO were significantly reduced.

Keywords:
Urgency, Pelvic organ prolapse, Detrusor overactivity
1.
de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, Kirby MG, Koelbl H, Espuna-Pons M, Milsom I, Tubaro A, Wagg A, Vierhout ME: Pelvic organ prolapse and overactive bladder. Neurourol Urodyn 2010;29:30-39.
2.
Costantini E, Giannantoni A, Rociola W, et al: Detrusor overactivity and urogenital prolapse (abstract 768). Paris, ICS-IUGA Annual Jointed Meeting, 2004.
3.
Costantini E, Lombi R, Micheli C, Parziani S, Porena M: Colposacropexy with Goretex mesh in marked vaginal and utero-vaginal prolapse. Eur Urol 1998;34:111-117.
4.
Costantini E, Mearini L, Bini V, Zucchi A, Mearini A, Porena M: Uterus preservation in surgical correction of urogenital prolapse. Eur Urol 2005;48:642-649.
5.
Costantini E, Lazzeri M, Zucchi A, Bini V, Mearini L, Porena M: Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience. Int Urogynecol J Pelvic Floor Dysfunct 2011;22:287-292.
6.
Zucchi A, Lazzeri M, Porena M, Mearini L, Costantini E: Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 2010;7:626-633.
7.
Long CY, Hsu SC, Sun DJ, Chen CC, Tsai EM, Su JH: Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse. Kaohsiung J Med Sci 2002;18:593-597.
8.
Rosenzweig BA, Pushkin S, Blumenfeld D, Bhatia NN: Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse. Obstet Gynecol 1992;79:539-542.
9.
Romanzi LJ, Chaikin DC, Blaivas JG: The effect of genital prolapse on voiding. J Urol 1999;161:581-586.
10.
Schimpf MO, O'Sullivan DM, LaSala CA, Tulikangas PK: Anterior vaginal wall prolapse and voiding dysfunction in urogynecology patients. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:721-725.
11.
Dietz HP, Clarke B: Is the irritable bladder associated with anterior compartment relaxation? A critical look at the ‘integral theory of pelvic floor dysfunction'. Aust NZ J Obstet Gynaecol 2001;41:317-319.
12.
Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10-17.
13.
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A, Standardisation Sub-committee of the International Continence Society: The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the In-ternational Continence Society. Neurourol Urodyn 2002;21:167-178.
14.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC: Functional bowel disorders. Gastroenterology 2006;130:1480-1491.
15.
Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M: Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct 2005;16:497-503.
16.
Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V: The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 2005;112:971-976.
17.
Bradley CS, Nygaard IE: Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 2005;106:759-766.
18.
Miedel A, Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M: Symptoms and pelvic support defects in specific compartments. Obstet Gynecol 2008;112:851-858.
19.
Sobhgol SS, Charandabee SM: Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:367-373.
20.
Burrows LJ, Meyn LA, Walters MD, Weber AM: Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 2004;104:982-988.
21.
Costantini E, Mearini E, Biscotto S, Mearini L, Giannantoni A, Porena M: Linking age, cystocele and abdominal straining (abstract 338). Eur Urol 2002;87(suppl 1):abstract 338.
22.
Fayyad AM, Redhead E, Awan N, Kyrgiou M, Prashar S, Hill SR: Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:191-197.
23.
Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M: Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. J Urol 2008;180:1007-1012.
24.
Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M: Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8-year follow-up. J Urol 2011;185:2236-2240.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.