title: Predictors of persistent detrusor overactivity in women with pelvic organ prolapse following transvaginal mesh repair.
abstract: OBJECTIVE
  The aim of this study was to investigate the contributing factors of persistent detrusor overactivity (DO) in women with advanced pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair.
  
  
  METHODS
  We retrospectively evaluated consecutive patients with DO and advanced POP who had undergone TVM in a tertiary hospital between 2010 and 2014. All patients received evaluations, including a structured urogynecological questionnaire, pelvic examination using the POP-Quantification System, scores of the Urogenital Distress Inventory and Incontinence Impact Questionnaire, and urodynamic testing before TVM repair and 6 months after surgery. Patient demographics, lower urinary tract symptoms, including urinary urgency, incontinence and frequency, and urodynamic findings were analyzed between women with and without persistent DO at 12 months after surgery.
  
  
  RESULTS
  Of 326 patients with POP who underwent TVM repair, 63 with preoperative DO were included. Urinary urgency was present in 27 (42.9%), and urgency incontinence was present in 26 (41.3%) patients. Nineteen (30.2%) patients had persistent DO after surgery. Patients with persistent DO had lower preoperative maximal flow rate (MFR), higher preoperative detrusor pressure at maximum flow, higher postoperative residual urine volume and higher rates of concomitant sacrospinous ligament suspension compared to those without DO. In the multivariate analysis, preoperative MFR and concomitant sacrospinous ligament suspension were associated with persistent DO.
  
  
  CONCLUSIONS
  Twenty percent of women with advanced POP had DO, and most of these cases resolved after prolapse repair. For women with lower preoperative MFR and concomitant sacrospinous ligament suspension, preoperative counseling should consist of a discussion about persistent DO and relevant urinary symptoms following TVM repair.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
authors.forename: Wu-Chiao
authors.initials: WC
authors.lastname: Hsieh
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ling-Hong
authors.initials: LH
authors.lastname: Tseng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D053201:Urinary Bladder, Overactive / Q000175:diagnosis*; D014549:Urinary Incontinence; D014563:Urodynamics; D014621:Vagina / Q000601:surgery
keywords: detrusor overactivity; overactive bladder; pelvic organ prolapse; transvaginal mesh; urodynamic study