Minimally Invasive Overactive Bladder Therapy After Prolapse Surgery.

Importance: Associations between pelvic organ prolapse and overactive bladder exist, yet little is known regarding minimally invasive overactive bladder therapy use among older women following prolapse surgery.

Objective: The aim of the study was to determine minimally invasive overactive bladder therapy use (onabotulinumtoxinA injection, percutaneous tibial nerve stimulation, sacral neuromodulation) in older women following prolapse surgery.

Study design: This was a retrospective cohort study of a 100% sample of fee-for-service Medicare beneficiaries who had prolapse surgery 2014-2015. The primary outcome was new minimally invasive overactive bladder therapy and the secondary outcome was new overactive bladder diagnosis within Medicare claims data, within 2 years of prolapse surgery. Data were stratified by surgery type (obliterative, apical, anterior/posterior, and apical with anterior/posterior). Modified Poisson regression models were used to calculate relative risk for each outcome.

Results: Among the 58,841 beneficiaries who underwent prolapse surgery, 1,120 (1.9%) received minimally invasive overactive bladder therapy within 2 years. Among those who underwent prolapse surgery and did not have a preexisting diagnosis of overactive bladder, 9.2% (2,580/28,160) had a new overactive bladder diagnosis within 2 years. Factors associated with the increased adjusted relative risk (aRR) of new minimally invasive overactive bladder therapy included surgery type (apical aRR 1.6, 95% CI, 1.2-2.2 compared to obliterative repair), concomitant stress urinary incontinence surgery (aRR 1.3, 95% CI, 1.2-1.5), preexisting overactive bladder (aRR 4.1, 95% CI, 3.4-4.8), and frailty (mild to severe frailty aRR 3.4, 95% CI, 2.7-4.3 compared to not frail).

Conclusion: Rates of minimally invasive overactive bladder therapy following prolapse surgery were low in a national cohort of female Medicare beneficiaries despite a high prevalence of disease.