Effect of prolapse repair on voiding and bladder overactivity.

PURPOSE OF REVIEW: To determine the effects of repair of pelvic organ prolapse (POP) on detrusor overactivity, overactive bladder (OAB) symptoms and voiding function. Understanding the cause of OAB in women with prolapse gives us more insight into the cause of detrusor overactivity and OAB in general. Understanding the different causes involved in OAB will allow us to target our treatments more effectively. This review discusses the evidence linking OAB and prolapse. Relevant studies or review articles were identified by performing a literature search using PubMed and MEDLINE.

RECENT FINDINGS: Prolapse and OAB may occur by chance together, but epidemiological studies support a link between OAB and prolapse. Also, POP repair (surgical correction or a ring pessary placement) is associated with improvement or resolution of OAB symptoms and detrusor overactivity. For these reasons, there seems to be a causal link between prolapse and OAB. The cause of OAB and detrusor overactivity is not fully understood, but theories relate to myogenic, neurogenic and obstructive elements. The most commonly accepted pathophysiology when prolapse is involved is that of increased bladder outlet obstruction or resistance. This is supported when the correction of POP improves voiding function, which is associated with a reduction in OAB.

SUMMARY: POP repair (surgery/ring pessary) has a positive effect on the resolution of OAB, detrusor overactivity and voiding dysfunction, providing a theory for a causal effect between the conditions. Larger prospective observational studies are needed.