Prolapse repair fails to improve sling outcomes in OAB patients

By Joanna Lyford, Senior medwireNews Reporter

Performing concomitant anterior compartment repair in women receiving a midurethral sling for overactive bladder (OAB) does not seem to offer any additional benefit, results of a cohort study indicate.

The only major predictor of clinical outcomes in the study was the development of postoperative complications, which were associated with less improvement in OAB symptoms.

Alexis Dieter (Duke University Medical Center, Durham, North Carolina, USA) and colleagues compared outcomes between 67 women with OAB who received a midurethral sling and 84 who received a sling and underwent concomitant anterior/apical prolapse repair. All women had bothersome mixed urinary incontinence (stress urinary incontinence [SUI] and OAB) at baseline.

The team hypothesised that women with mixed urinary incontinence would experience a greater improvement in the OAB component of their symptoms if they underwent both procedures rather than sling placement alone.

The study, published in the International Urogynecology Journal, was retrospective and the choice of surgery was not randomised but at the discretion of the treating physician. Women who underwent only sling placement tended to be younger, were less likely to be postmenopausal and had less severe prolapse.

Six weeks after surgery, both groups of women experienced a significant reduction in OAB symptoms, with the majority of patients showing at least a 10-point change in Overactive Bladder Questionnaire Symptom Severity (OAB-q SS), which is considered to be the threshold for a clinically important effect.

The proportion of women who achieved a clinically important change was 85% in those who underwent sling placement only versus 76% in those who underwent concomitant anterior compartment repair, a nonsignificant difference.

Secondary outcomes indicated that most patients experienced an improved quality of life with less symptom bother after surgery, with no difference between the cohorts. With regard to specific symptoms, 81% and 88% of women were free of OAB and SUI symptoms, respectively, with no difference between groups.

Finally, linear regression analysis identified just one factor that predicted change in OAB-q SS scores, namely, the presence of postoperative complications, which were associated with a smaller improvement in symptom severity. Twenty-three percent of patients experienced at least one postoperative complication, the researchers note, again with no difference between groups.

They conclude: “Our data may be useful in counseling patients affected by MUI and [pelvic organ prolapse] regarding preoperative treatment planning and expectations following surgery.”

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