Overactive bladder (OAB) is known to occur at a high rate in patients with pelvic organ prolapse (POP), and it has been reported that it can be improved by POP surgery. We investigated changes in OAB symptoms in patients who underwent robotic sacrocolpopexy (RSC) at our hospital.

We targeted 77 patients who underwent RASC between July 2020 and November 2024, and retrospectively examined the preoperative OAB complication rate, preoperative and postoperative OABSS, and OABSS-VAS, which shows the level of distress for OAB symptoms. Patients who scored more than 2 points in Q3 and more than 3 points in total OABSS were defined as OAB. Wilcoxon signed-rank test was used to compare OABSS and OABSS-VAS before and after RSC.

Median age was 73 years old, BMI was 24.2, and observation period was 12 months. Of the 77 cases, 10 were POP-Q stage II, 38 were stage III, 27 were stage IV, and 2 were unknown.  54 patients had anterior prolapse,  16 patients had posterior prolapse,  21 had apical prolapse. 53 patients (69%) had preoperative OAB.
OABSS was confirmed 3 months after RSC, and it showed significant improvement in Q1 (0.8±0.5 vs 0.6±0.5, p=0.0004), Q2 (1.6±1.0 vs 1.2±0.8, p=0.004), Q3 (2.3±1.5 vs 1.2±1.4, p<.0001), Q4 (1.7±1.5 vs 0.8±1.3, p<.0001), and total (6.3±3.3 vs 3.8±3.1, p<.0001). In addition, OABSS-VAS also improved significantly in Q1 (56.8 ± 23.9 vs 30.8 ± 25.3, p < .0001), Q2 (48.5±31.0 vs 30.5±24.8, p =0 .0001), Q3 (61.6±27.0 vs 31.9±25.0, p<.0001), Q4 (62.5±30.2 vs 34.1±27.3, p<.0001), and VAS-QOL (72.4±24.5 vs 33.9±25.4, p<.0001). 16 cases had postoperative OAB, in which 13 cases (13/53, 24.5%) had OAB from presurgery, and 3 cases (3/24, 12.5%) were de novo OAB. Comparing the persistent OAB group and OAB cured group, the preoperative OABSS Q3 (3.2±1.4 vs 2.6±1.2, p=0.03), Q4 (2.6±1.6 vs 2.0±1.2, p=0.04), and total (8.4±3.5 vs 7.0±2.9, p=0.04) score were significantly higher in the persistent OAB group.

In previous report, 55-85% of POP patients suffer from OAB and surgical treatment would significantly improve postoperative OAB symptoms and UUI. In our study, comparing before and after RSC, OABSS and VAS showed significant improvement in all items.
Consistent with previous reports, OAB symptoms were significantly improved after RSC, and the level of distress associated with OAB symptoms was also improved.
The incidence of de novo UUI has been reported to be 7.5-30%. De novo UUI was observed in 3 cases (12.5%) in our study, but most were mild and only one case required additional treatment.
Padoa et al. reported that BMI (27 vs 25.7, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), UUI (51.46% vs 80.26%, p = 0.0001), DO (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate (13.9 ml/s vs 15 ml/s, p = 0.04) were associated with persistent postoperative urgency after POP surgery. Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1-7.2]; p
= 0.04) as predictive factor for persistent urgency.
There was no association between BMI, but preoperative OABSS Q3, Q4, and total score were associated with persistent OAB after RASC.

Although the severity and distress of OAB significantly improved after RSC, persistent OAB were observed in 24.5% and de novo OAB was observed in 12.5%. Preoperative urgency and UUI might be risk factors for persistent OAB after RSC.

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Padoa A, et al: Int Urogynecol J:2023