The Role of Anterior Vaginal Prolapse in Co-Existent Underactive Overactive Bladder Syndrome-A Retrospective Cohort Study

Background: CUOB (co-existent underactive overactive bladder) syndrome is a clinical entity that embraces storage and emptying symptoms, not strictly correlated with urodynamic findings. We assessed the differences between patients diagnosed with CUOB with/without cystocele. Methods: The study group was allocated from 2000 women who underwent urodynamic studies between 2008 and 2016. The demographic and clinical data of 369 patients with complaints consistent with CUOB were retrieved. The study group was subdivided using the Pelvic Organ Prolapse Quantification System. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) was used to quantify LUTS severity. Results: A total of 185 women had no or grade I cystocele (group 1), and 185 had grade II or III cystocele (group 2). No difference in mean age was computed. Patients from group 1 had a higher BMI (27 vs. 25, p = 0.02). Risk factors for prolapse, such as parity (1.7 vs. 2.1, p = 0.001) and maximal birthweight (3460 g vs. 3612 g, p = 0.049), were higher in group 2. Pelvic Organ Prolapse symptoms were 4.5 times more frequent in group 2 [n = 36/185 (19.5%) vs. n = 162/184 (88%) p < 0.001]. The rate of stress (70.8% vs. 55.4%, p = 0.002) and urge (64.9% vs. 50%, p = 0.04), urinary incontinence, and ICIQ-UI-SF scores (8 vs. 5, p < 0.001) were higher in group 1. Qmax measured lower in group 2 (17 vs. 15 mL/s, p = 0.008). Detrusor pressure at maximum flow was identical (24 cm H2O). The Bladder Contractility Index (BCI) was higher in group 1 (108 vs. 96.5, p = 0.017), and weak contraction (BCI < 100) was more common in group 2 (73/185; 39.5% vs. 95/184; 52.7%, p = 0.011). Conclusions: Based on our results, we assume that CUOB could be further subdivided based on its association with cystocele. The effect of prolapse repair in women with CUOB and cystocele remains to be evaluated in order to afford better counseling in the future.