See Liedl B, Inoue H, Sekiguchi Y, et al. Is overactive bladder in the female surgically curable by ligament repair?Cent European J Urol. 2017; 70: 51-57.
611 patients with apical prolapse and concurrent
symptoms were assessed. Only data of patients presenting
for a 12 month follow up are presented. Mean
age was 69.62 ±13.17 years. Prolapse varied between
2nd degree POPQ (n = 210) and 3rd /4th degree POPQ (n = 390). Of those undergoing TFS surgery 93 (15%) had faecal incontinence, 194 (31%) had pelvic pain, 254 (41%) had nocturia, 317 (52%) had urinary urge incontinence, and 310 (51%) had urinary frequency (Figure 3). There was no correlation between degree of prolapse and symptom severity
Explanation by the authors for OAB and nocturia cure
The TFS mechanically supports the vagina
and bladder base much as joists (ligaments) support
a plaster ceiling (vagina). We believe that it is this
mechanical support which is crucial in preventing
the bladder base stretch receptors prematurely activating
the micturition reflex to cause urge, frequency,
and nocturia [3, 4, 5].
Overactive mechanism is an intrinsic detrusor malfunction.
Repair of the ligament will not influence the urgency
OAB is purely an intrinsic bladder issue that is directly related to detrusor muscle overactivity causing frequency and urgency. Sometimes mixed UI becomes OAB after correction of prolapse.
The most frequent complication after correction of a prolapse is stress urinary incontinence. So it's better before surgery to perform Uro dynamic study and inform the patient that they need a sling
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