Laparoscopic Sacrocolpopexy Can Alleviate Postoperative Overactive Bladder Symptoms With or Without Urinary Incontinence in Patients With Both Preoperative Symptoms

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Int Neurourol J. 2025;29(3):164-171

Publication date (electronic) : 2025 September 30

doi : https://doi.org/10.5213/inj.2550002.001

Kenji Kuroda, Koetsu Hamamoto, Kazuki Kawamura, Ayako Masunaga, Hiroaki Kobayashi, Keiichi Ito

Department of Urology, National Defense Medical College, Tokorozawa, Japan

Corresponding author: Kenji Kuroda Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan Email: kksmy@sa2.so-net.ne.jp

Received 2024 November 30; Accepted 2025 March 23.

Abstract

INTRODUCTION

Pelvic organ prolapse (POP) is defined as the downward displacement of one or more pelvic organs, such as the bladder, uterus, bowel, or rectum. POP can cause symptoms such as pelvic pressure, vaginal bulging, and incomplete emptying of urine or feces [1]. POP may be caused by weak or damaged pelvic floor muscles because of obesity, persistently high abdominal pressure, and birth trauma. POP-induced pelvic organ displacement and decline greatly affect the daily lives and careers of women. At some point in the lives of these women, approximately 20% have undergone POP surgery [2].

Patients with POP also experience symptoms of an overactive bladder (OAB), which is characterized by frequency or nocturia with urinary urgency with or without urge urinary continence (UUI) [1, 3]. The EPIC (Epidemiology Urinary Incontinence and Comorbidities) study demonstrated that 13% of women suffer from OAB symptoms regardless of age [4]. However, the pathophysiology of OAB is not well known.

POP and OAB symptoms frequently coexist. A recent population-based study reported that 40% of women with POP experienced at least one troublesome OAB symptom, and 82% had at least one OAB symptom of any grade [5]. Among other proposed mechanisms, the integral theory explains the correlation of OAB symptoms with POP, which designates that OAB is caused by anatomical defects and damage to the pelvic floor musculoligamentous system [6]. Therefore, conservative or surgical treatments for POP could improve OAB symptoms after treatment.

POP can be treated with pelvic floor exercises, pessary, and surgery. Typically, transvaginal mesh surgery (TVM) and laparoscopic sacrocolpopexy (LSC) are performed for the treatment of POP. Over the past several years in Japan, POP has been treated with LSC or TVM [7]. A randomized controlled trial that compared LSC with TVM for POP repair showed higher success rates and lower reoperation rates after LSC than after TVM [8]. Both procedures appear to offer favorable results for the surgical treatment of POP [7, 9]. However, LSC has several benefits owing to its correlation with reduced recurrence rates, lower incidence of dyspareunia, shorter length of postoperative hospital stay, and faster recovery period [10, 11]. Accordingly, it has long been considered the gold standard for POP treatment, and robot-assisted sacrocolpopexy is now becoming the new gold standard technique.

This study analyzed data of patients with POP who underwent LSC using Polyform (Boston Scientific, Japan) or ORIHIME (Kono Seisakusho, Japan) at our institution to determine the factors leading to the presence of postoperative OAB symptoms or its improvement after LSC.

MATERIALS AND METHODS

Patients

The medical records of 97 patients who underwent LSC between June 2016 and October 2023 were retrospectively reviewed. Surgery is indicated for stage ≥2 POP with symptoms, such as hydronephrosis and/or hydroureter caused by POP, or even in asymptomatic cases.

This study included patients who underwent LSC for POP using Polyform or ORIHIME throughout the research period; those who chose not to participate or those who underwent LSC using Gynemesh PS (Johnson and Johnson, Japan) were excluded.

The median postoperative observation period was 12.3 months (interquartile range [IQR], 12.1–18.2 months). The median operative time calculated from all patients was 3.03 hours (IQR, 2.55–4.16 hours). Table 1 presents clinical data such as age, body mass index, presence of diabetes mellitus, pelvic organ prolapse quantification stage, past history of hysterectomy, blood loss, operative time, mesh products used, preoperative voiding dysfunction, preoperative OAB, preoperative urinary incontinence (UI), and intraoperative complications.

Table 1.

Clinical characteristics of the LSC patients (N=97)

RESULTS

Patients’ background is presented in Table 1. Intraoperative bladder injury was observed in 4 patients and anterior vaginal wall injury in 8; however, no serious postoperative complications were noted. All of them were rated as Clavien–Dindo classification grade I [16].

The results of the correlation analysis between pre- and intraoperative factors and the presence of postoperative OAB symptoms revealed that the presence of preoperative OAB or UI was significantly associated with postoperative OAB (both P<0.05). Moreover, the presence of both symptoms was significantly associated with postoperative OAB (P=0.010) (Table 2).

Table 2.

Association between the presence of postoperative OAB symptoms and pre- and intraoperative variables

The findings of another correlation analysis between pre- and intraoperative factors and improvement of postoperative OAB symptoms revealed that the presence of preoperative OAB and that of either symptom were significantly associated with postoperative OAB improvement (both P<0.05) (Table 3).

Table 3.

Association between postoperative OAB improvement and pre- and intraoperative variables

Multivariate logistic regression analysis was also performed to evaluate the independent factors for postoperative OAB symptoms. In the univariate and multivariate analyses, the presence of both OAB and UI and operative time were significant predictors among pre- and intraoperative factors (P=0.005, P=0.020, respectively) (Table 4). Further univariate and multivariate analyses of multiple logistic regression analysis revealed that the presence of either of the symptoms was an independent contributor to postoperative OAB improvement (P=0.015) (Table 5).

Table 4.

Factors contributing to the presence of postoperative OAB symptoms in multiple logistic regression analysis

Table 5.

Factors contributing to postoperative OAB improvement in multiple logistic regression analysis

The OABSS improved significantly 3–12 months after surgery in the group with OAB ≥3; 3–12 months after surgery in the group with preoperative UI (+); 6 and 12 months after surgery in the group with preoperative UI (-); and 3–12 months after surgery in the group with both or either of the symptoms in box plots (all P<0.05) (Fig. 1A-C).

Fig. 1.

Box plots reveal significant decreases in overactive bladder symptom score 3–12 months after surgery (3–12 POM) in the group with preoperative OAB of ≥3 (A), group with preoperative urinary incontinence (UI) (+) and UI (−) (B), group with both OAB and UI, and group with either OAB or UI (C). *Significantly different from the preoperative status (BS) (P<0.001), **Significantly different from the preoperative status (BS) (P<0.05). BS, before surgery; POM, postoperative months; OAB, overactive bladder; UI, urinary incontinence; NS, not significant.

DISCUSSION

In the correlation analysis of this study, the presence of both OAB and UI was associated with the presence of postoperative OAB symptoms (Table 2). In another correlation analysis, the presence of preoperative OAB and either of the symptoms were significantly associated with postoperative OAB improvement (Table 3). Multiple logistic regression analysis showed that the presence of both symptoms was an independent factor for postoperative OAB symptoms (Table 4). Conversely, the presence of either of the symptoms could help improve postoperative OAB symptoms (Table 5). From Tables 3 and 5, the presence of preoperative OAB symptoms seemed to contribute more to postoperative OAB improvement. Box plots also showed a significant difference in postoperative OABSS in every group (Fig. 1). From these findings, LSC could improve both OAB and UI symptoms even in patients with both symptoms. In other words, LSC could alleviate OAB as well as UI.

Lower urinary tract symptoms such as BOO and OAB often occur in patients with POP. In these patients, BOO is a common cause of OAB symptoms and UUI and is considered a significant contributing factor to these symptoms [17]. According to several earlier studies, OAB symptoms subsided following effective treatment for POP [17-20]. In a previous study, 53% (22 of 40) of the patients who underwent non-mesh procedures for prolapse repair experienced resolution of OAB symptoms, and better postoperative OAB scores were significantly associated with the maximal flow rate [20]. In another study, preoperative detrusor obstruction was the only significant predictor of symptom alleviation in patients with POP, and OAB symptoms were resolved after TVM [21]. In patients with severe POP, 63% (24 of 38) of UUI cases resolved following prolapse correction surgery or that urgency and frequent symptoms significantly decreased 6 months and 1 year following vaginal reconstructive and obliterating procedures [22, 23]. The authors proposed that mesh repair-induced postoperative OAB improvement was associated with urethral obstruction release. In the present study, 78 out of 97 (80.4%) patients had an OAB total score of ≥3 before surgery, and 47 out of 78 patients (60.3%) still had an OAB total score of ≥3; however, only 12 out of 78 patients (15.4%) had a worse OAB total score 12 months after LSC. Therefore, it is likely that LSC also reduced BOO and enhanced pelvic floor support in this study as seen in earlier studies.

LSC offers numerous advantages, such as less intraoperative blood loss and a shorter hospital stay; thus, it has been a preferred procedure in recent years [24, 25]. Compared with traditional surgical methods, its postoperative recurrence rate is lower; however, it requires extended operating hours and a higher degree of expert skills [25]. When LSC or TVM is recommended to patients with POP, some patients choose LSC, which appears to have a lower recurrence rate and fewer complications. Native tissue repair is not as commonly selected because of concerns regarding increased recurrence rates. In a previous report, UI was significantly lower in patients who underwent LSC as well as TVM, and the ICIQ-SF scores were also significantly lower in patients who underwent either of the surgical methods [26]. Therefore, this study was conducted based on the prediction that OABSS would improve postoperatively in patients who underwent LSC along with ICIQ-SF and that OAB symptoms would be more significantly alleviated in patients with preoperative OAB symptoms and/or UI.

This study has several limitations. First, it is a clinical study at a single institution. Second, the study population is relatively small. Third, the median follow-up period of 12.3 months was relatively short. Thus, to increase the generalizability of the data and reach a consensus on these limitations, a more comprehensive multi-center study in the future would provide more conclusive evidence based on these findings. A direct comparison with TVM studies would also further increase the statistical power and robustness of the findings of this study. Moreover, longer observation periods would further support the validity and long-term reliability of the study results.

In conclusion, LSC may have the potential to treat OAB symptoms with or without UI. The presented findings indicate that LSC would improve OAB symptoms in patients with preoperative OAB and/or UI compared with those without such symptoms.

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