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abstract

242 - PROSPECTIVE EVALUATION OF OVERACTIVE BLADDER SYMPTOMS IN A COHORT OF PATIENTS UNDERGOING VAGINAL HYSTERECTOMY AND ANTERIOR COLPORRHAPHY FOR ADVANCED PELVIC ORGAN PROLAPSE

242

PROSPECTIVE EVALUATION OF OVERACTIVE BLADDER SYMPTOMS IN A COHORT OF PATIENTS UNDERGOING VAGINAL HYSTERECTOMY AND ANTERIOR COLPORRHAPHY FOR ADVANCED PELVIC ORGAN PROLAPSE

B. LIRAZAN, A. J. AMIN-ONG, L. T. PRODIGALIDAD;
Univ. of The Philippines - Philippine Gen. Hosp., Manila, Philippines.

Introduction: Pelvic organ prolapse (POP) is often accompanied by bothersome symptoms of overactive bladder (OAB) namely urinary frequency, urgency, nocturia and urgency incontinence (1). Improvement of OAB related symptoms have been observed after surgical and non-surgical ways to resolve the prolapse in literature (2) but the results are difficult to interpret due to the wide variety of patient population and surgical techniques used for analysis.
Objective: This study aims to prospectively evaluate the impact of surgery on the improvement of OAB symptoms on a homogenous cohort of patients who underwent vaginal hysterectomy and anterior colporrhaphy for advanced stage POP.
Methods: This is a prospective observational study involving patients with OAB who underwent vaginal hysterectomy and anterior colporrhaphy for advanced stage POP in a tertiary referral center. Objective change in OAB symptom bother was measured using a 3-day bladder diary and an office cystometry while subjective change in the quality of life was measured through the Overactive Bladder-Validated 8-question Awareness Tool (OAB V-8) done before and 6 weeks after surgery.
Results: A total of 43 patients undergoing vaginal hysterectomy, McCall culdoplasty, anterior and posterior colporraphy ± bilateral iliococcygeal fixation were included for analysis. Ninety-three percent (n=40) of the participants were defined to have "improved" OAB symptoms and none of the patients had "persistent" OAB symptoms. A statistically significant decrease in degree of OAB symptom bother is noted based on a decrease of baseline OAB-V8 score from 20.47 ± 6.70 to 5.09 ± 4.06 6 weeks after surgery. There is also a statistically significant decrease in the average number of daytime voiding episodes and an increase in the average volume per void compared to baseline levels as noted in the 3-day diary. In the filling cystometry, there was an observed increase in the volumes of the first, strong and maximum cystometric capacity which were also all found to be statistically significant when compared to baseline values with no patient developing urinary retention and de novo-stress urinary incontinence 6 weeks after surgery.
Conclusions: This study proves that patients suffering from both advanced stage POP and OAB experience significant resolution of OAB symptoms after vaginal hysterectomy and anterior colporrhaphy. This information can be utilized in counseling patients regarding the high likelihood of OAB symptom resolution following prolapse repair.
References: 1. IUJ. 21.1 (2010): 5-26.
2. IUJ. 2013 Aug 1; 24(8):1303-8.

Table 1. Primary outcome and summary of OAB-V8 questionnaire scores amongst all participants

Primary Outcome Interpretation

Improved

40 (93.02%)

Equivocal

3 (6.98%)

Persistent

0 (0%)

OAB-V8 Score

Baseline/
Preoperative

6 Weeks
After Surgery

Average Overall Score

20.47 ± 6.70

5.09 ± 4.06

% Change

73.98 ± 20.45 %

 

Summary of 3-day bladder diary results and office cystometry findings amongst all participants

3-Day Bladder Diary

Baseline/Preoperative

6 Weeks After Surgery

Number of micturitions/day

9 ± 3.59

6 ± 1.53

% Change

25.12 ± 29.86 %

Average volume per void

315.01 ± 79.17 ml

400.25 ± 56.54 ml

% Change

33.78 ± 34.28 %

Office Cystometry

Baseline/Preoperative

6 Weeks After Surgery

Volume at first desire to void (ml)

181.86 ± 48.71 ml

211.16 ± 56.07 ml

% Change

26.87 ± 26.83 %

Volume at strong desire to void (ml)

335.12 ±80.01 ml

407.67 ±55.71 ml

% Change

26.87 ± 26.83 %

Maximum cystometric capacity

403.95 ± 74.42 ml

462.09 ± 56.89 ml

% Change

16.92 ± 19.62 %