To check evidence that symptoms identical with those constituting “underactive bladder” (UAB) and “overactive bladder” (OAB) are caused by apical prolapse and cured by repair thereof.

After repair of apical prolapse by mesh tape reinforcement of lax uterosacral ligaments (USL) data form 1,671 women were retrospectively examined to determine the presence of OAB and UAB symptoms and to check, how many were cured surgically. Thereby 3 different techniques were performed: elevate (n = 277), “Posterior IVS” (n = 1,049), and TFS cardinal (CL)/USL (n = 345).

Symptoms identical with those comprising UAB and OAB were cured in up to 80% of cases following surgical repair of the CL/USL complex.

These symptoms may be consistent with symptoms of the posterior fornix syndrome, which comprises 4 main symptoms: micturition difficulties, urge/frequency, nocturia, chronic pelvic pain, all consequent on USL laxity. Surgical cure of OAB and UAB is inconsistent with existing definitions, which imply pathogenesis of the detrusor muscle itself. A reconsideration and reformulation of existing definitions may be required. Altering UAB definition to “bladder emptying difficulties” and return to former definitions for OAB such as “detrusor” or “bladder instability” may help to restore compatibility with surgical cure of these conditions.

Urologia internationalis. 2019 Jun 11 [Epub ahead of print]

Bernhard Liedl, Klaus Goeschen, Alexander Yassouridis, Hiromi Inoue, Burghard Abendstein, Ion-Andrei Müller-Funogea, Alpaslan Caliskan

Urologische Klinik Planegg, Zentrum für Rekonstruktive Urogenitalchirurgie, Planegg, Germany, ., University of Hannover, Gynecology, Hannover, Germany., LMU München, Ethikkommission, München, Germany., LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan., Akademisches Lehrkrankenhaus Feldkirch, Gynäkologie und Geburtshilfe, Feldkirch, Austria., St.-Antonius-Hospital Eschweiler, Inkontinenz- und Beckenbodenzentrum, Eschweiler, Germany., Ozel Odak Hastanesi, Department of Gynecology and Obstetrics, Denizli, Turkey.