Prolapse and oab symptoms what should be treated first analysis of 475 surgical cases

Introduction: The prevalence of Overactive Bladder (OAB) is greater in patients with Pelvic Organ Prolapse (POP), the mechanisms are not completely elucidated. Very often, clinicians are exposed to make the decision what to treat first: POP or OAB algorithm. Literature reports high percentages of bladder symptoms improvement after POP repair. Our aim was to evaluate the persistence of OAB symptoms. Methods: Retrospective cohort study, inclusion criteria were: Symptomatic POP stage II ó>, preoperative urgency and/or urge-Incontinence and apical surgeries, Sacrocolpopexy( SCP), Vaginal apical suspension VAS: High uterosacral or sacrospinous ligament fixation and Colpocleisis. Patients with Lower Urinary Tract Disfunction or neurologic disorders were excluded. Logistic regression analysis and multivariate analysis were performed. Results: Between 2008-2019, 475 patients met the criteria. Mean age was 65, postmenopausal 77.9%, forceps delivery 27.8%, smokers 20%, diabetic 16.6%. The mean Incontinence Severity Index (ISI) score was 7 (SD±4) Pads per day 3(SD±3). Body mass Index BMI 29.2(SD ±4.2). Preoperatory POP-Q stage II 20.4%, III 66.3% and IV 12.6%. Distribution by surgery: SCP 152(32%), VAS 226(47.6%) and Colpocleisis 97(20.4%). Mean follow up 22.9(SD±25.8) months. After surgery, 68.8% (327) patients were asymptomatic, from them, 82.8%(271) never again had OAB symptoms. 56(17.1%) re-onset of symptoms. 57(12%) persisted with OAB treatment. 11.9% anticholinergics, 0,2% Percutaneous Nerve Stimulation (PTNS) and 0% botox or SNM. De novo treatments were: anticholinergics 62(13.2%), PTNS 24(5.1%) SNM in 2(0.4%). The mean time between surgery and symptoms re-onset was 2.7(SD ±10.4) months. After cox proportional hazard analysis, no differences were found between the type of surgery and persistence of symptoms. The risk factors for OAB persistence were Diabetic with an OR 1.844(CI 95% 1.185-2.870) and higher (6 o>) ISI score before surgery OR 1.07(CI 95% 1.018-1.126). Conclusion: 68.8% of patients improved their symptoms after surgery, vast majority (82.8%) never had OAB symptoms again. This information is relevant putting in the debate that OAB could be improved after surgical correction of apical prolapse, so it should be treated first. In our study, the diabetic status was associated with 84% higher risk for symptoms persistence. However, several mechanisms might also play a role. Our results should be interpreted with caution due to the retrospective nature of the study.