The following is a summary of “Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse; the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)” published in the December 2022 issue of Obstetrics & Gynecology by Kowalski et al.
The relationship between lower urinary tract symptoms,, including an overactive bladder and pelvic organ prolapse, as well as their natural course, still need to be better understood. Previous cross-sectional investigations found contradictory connections between prolapse and symptoms of the lower urinary tract. For a study, researchers sought to establish a baseline relationship between lower urinary tract symptoms and prolapse and to compare symptoms over a 12-month period in women with and without prolapse. The investigation of relationships between prolapse lower urinary tract symptomsy tract served as a secondary goal. They proposed three hypotheses: lower urinary tract symptoms are present in individuals with prolapse, lower urinary tract symptoms are stable over time in patients with and without prolapse, and prolapse therapy is related improveder urinary tract symptoms.
Women who participated in the Observational Cohort Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network and provided sufficient 12-month follow-up data were included. Treatment for prolapse and symptoms of the lower urinary tract was carried out in accordance with the standard of care during follow-up. The Overactive Bladder, Obstructive, and Stress Urinary Incontinence subscales of the Lower Urinary Tract Symptoms Tool, as well as the Urogenital Distress Inventory-6 Short Form were used as outcome measures. Pelvic Organ Prolapse Quantification System points Ba, C, or Bp were largely used to determine if prolapse occurred were >0 (beyond the hymen). For each lower urinary tract symptom outcome and prolapse predictor, mixed-effects models with random effects for patient slopes and intercepts were built, taking into account other variables. For comparisons between less frequently occurring groups, the research showed >90% power to detect differences as minor as 0.4 standard deviations (eg, prolapse vs not).
A total of 371 women examined, 313 (84%) of whom did not have prolapse, and 58 (16%) of whom did. In the research, prolapsed women were older (64.6±8.8 vs 55.3±14.1 years; P<.001) and more likely to get pessary therapy (26% vs 4%; P<.001) and prolapse surgery (28% vs 1%; P<.001). Individuals with prolapse had lower average baseline total severity ratings on the Lower Urinary Tract Symptoms Tool than participants without prolapse (38.9±14.0 vs 43.2±14.0; P=.036), but there were no differences in average scores between prolapse groups on other measures. Average scores were considerably lower (better) for all urine outcomes at 3 and 12 months compared to baseline (all P<.05). Pelvic organ prolapse measurement, visit, and time-dependent prolapse therapy groups did not interact statistically significantly in mixed-effects models (P>.05 for all regression interaction coefficients). Pelvic Organ Prolapse Quantification System Ba, Bp, and point of maximal vaginal descent all showed a statistically significant positive correlation with the Lower Urinary Tract Symptoms Tool obstructive severity score. The Pelvic Organ Prolapse Quantification System Ba and point of maximal vaginal descent were statistically significantly negatively correlated with the Lower Urinary Tract Symptoms Tool overall severity scale. There were no further significant relationships between prolapse and symptoms of the lower urinary tract (P>.05 for all regression coefficients). There were few changes in symptoms across prolapse groups; all regression coefficients (expressed as an additive percentage change in each score) ranged from -5 to 5. (standard deviation of outcomes ranged from 14.0–32.4).
Obstructive symptoms were positively related to prolapse among women seeking treatment for urinary symptoms, but the intensity of total lower urinary tract symptoms was adversely associated with prolapse. Regardless of prolapse status, including in individuals with treated prolapse, untreated prolapse, and without prolapse, Lower Urinary Tract Symptoms Tool scores increased during a 12-month period.
Reference: ajog.org/article/S0002-9378(22)00594-4/fulltext
