title: A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of transvaginal prolapse surgery on overactive bladder symptoms in elderly women.
  
  
  METHODS
  Women (> or = 65 years old) with stage III or IV prolapse who enrolled in a prospective study that compared vaginal reconstructive surgery (n = 39) to obliterative surgery (n = 26) and who underwent preoperative urodynamics are the subjects of this study. The women completed the Pelvic Floor Distress Inventory at baseline and again 6 months and 12 months after surgery. Postoperative changes in symptoms of urinary urgency, frequency, and urge urinary incontinence were assessed. The association between a baseline urodynamic diagnosis of detrusor overactivity and pre- and postoperative overactive bladder symptoms was also determined.
  
  
  RESULTS
  Data were analyzed from 65 subjects with a mean age of 75.3 years (range, 65.5-87.0 years). Detrusor overactivity was documented in 25% of subjects. There was no difference in the proportion of baseline urge incontinence (P = .38), urinary frequency (P = .53), or urgency (P = .76) in comparing women with and without detrusor overactivity. Surgery resulted in a significant reduction of urgency and frequency symptoms 6 months after surgery and a similar significant reduction in urgency and urge incontinence at 1 year after surgery. Overall, a clinically and statistically significant improvement in the irritative subscale of the Pelvic Floor Distress Inventory was noted at 6 months (18.3%; P < .0001) and 12 months (17.6%; P < .0001) after surgery. In our cohort, performance of a mid urethral sling, a bladder neck sling, or a Kelly plication was not associated with a reduction in postoperative symptoms of urgency, frequency, or urge incontinence (P = .48). Likewise, there was no difference in postoperative symptom reduction (urgency, frequency, or urge incontinence) between women who received reconstructive surgery vs women who had obliterative surgery (P = .84).
  
  
  CONCLUSIONS
  Vaginal surgery for stage III or IV pelvic organ prolapse significantly reduces overactive bladder symptoms in elderly women. In our cohort, symptom reduction was unrelated to the type of vaginal surgery (obliterative vs reconstructive) or the inclusion of a procedure to treat stress incontinence. Furthermore, preoperative urodynamic findings did not correlate with the presence or absence of overactive bladder symptoms.
authors.affiliation: Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Foster
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Parasio
authors.forename: Mark D
authors.initials: MD
authors.lastname: Walters
authors.forename: Alison C
authors.initials: AC
authors.lastname: Weidner
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000503:physiopathology; D053202:Urinary Incontinence, Urge / Q000175:diagnosis; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*