Surgical Treatment of Pelvic Organ Prolapse and Overactive Bladder: A Systematic Review and Meta-Analysis.

Abstract

Background: Pelvic organ prolapse (POP) frequently coexists with overactive bladder (OAB) symptoms, yet the impact of surgical correction on OAB outcomes remains incompletely characterized across different surgical approaches.

Objectives: To quantify OAB symptom resolution rates following POP surgery, compare outcomes across surgical techniques, evaluate de novo OAB incidence, and identify predictive factors for postoperative OAB persistence or development.

Search strategy: Comprehensive search of MEDLINE, Embase, Web of Science, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and LILACS through December 31, 2024, limited to English language articles.

Selection criteria: Comparative studies (randomized controlled trials and observational studies) including adult women with symptomatic POP (POP-Q stage ≥II) undergoing surgical correction, reporting validated OAB outcomes with minimum 3-month follow-up.

Data collection and analysis: Three independent reviewers extracted data using predefined criteria. Random-effects meta-analyses with Freeman-Tukey double arcsine transformation were performed. Quality assessment employed Cochrane Risk of Bias 2.0, Newcastle-Ottawa Scale, and GRADE methodology.

Main results: Twenty-four studies encompassing 7739 women (7095 analyzed) were included. Overall OAB resolution rate was 58.0% (95% CI: 55.9%-60.1%; I² = 83.9%). No significant differences emerged between vaginal, laparoscopic/robotic, or abdominal approaches (p = 0.62), or between mesh-augmented versus native tissue repairs (p = 0.48). Compartment-specific analysis revealed anterior/apical repairs achieved significantly higher resolution (75.8%, 95% CI: 73.2%-78.3%) compared to isolated posterior repairs (28.3%, 95% CI: 20.1%-37.9%; p < 0.001). De novo OAB incidence ranged 0%-14.3%, though reporting was limited to 6 studies.

Conclusions: POP surgery resolves preexisting OAB in approximately three-fifths of patients, with anatomical compartment representing the strongest predictor. Anterior/apical prolapse correction offers superior OAB outcomes compared to posterior repair, independent of surgical approach or mesh utilization.