Association of preoperative detrusor overactivity with postoperative urgency symptoms after pelvic organ prolapse surgery: a retrospective cohort analysis

Urgency and urgency urinary incontinence (UUI) may persist despite anatomically successful pelvic organ prolapse (POP) surgery. This study evaluated whether preoperative detrusor overactivity (DO) was associated with persistent postoperative urgency/UUI and assessed the incremental predictive value of urodynamic parameters beyond routine clinical assessment alone. This retrospective observational cohort study included 127 women with POP stage II–IV and preoperative urgency/UUI who underwent multichannel urodynamic studies before pelvic reconstructive surgery between January 2015 and June 2025. Persistent postoperative urgency/UUI at 3–6 months was assessed using the Thai version of the Pelvic Floor Bother Questionnaire with physician documentation. Multivariable modified Poisson regression with robust variance estimation was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Model discrimination was evaluated using receiver operating characteristic curves and area under the curve (AUC). The primary multivariable model was parsimonious and prespecified, comprising preoperative DO, baseline urgency severity, concurrent urgency urinary incontinence, and age (8 events per variable); the fully adjusted model was retained as a sensitivity analysis. Estimate stability was assessed by leave-one-out refitting and by a sensitivity analysis restricted to the vaginal surgical approach. Persistent postoperative urgency/UUI occurred in 40 of 127 women (31.5%). Preoperative DO was present in 24 women (18.9%); persistent symptoms occurred in 37.5% with DO versus 30.1% without. In the primary model, the aRR for DO was 1.23 (95% CI 0.67–2.25; p = 0.51), an interval compatible with a one-third reduction to a more than two-fold increase in risk; the estimate was stable across leave-one-out refits (1.11–1.31) and when restricted to the vaginal approach (1.36, 95% CI 0.74–2.53). Two of 127 women (1.6%) had low bladder compliance, and both had persistent symptoms. The clinical model showed poor discrimination (AUC 0.630, 95% CI 0.525–0.734), and adding urodynamic variables did not significantly improve it (AUC 0.681, 95% CI 0.579–0.782; DeLong p = 0.19); adding DO alone changed the AUC by 0.004. Preoperative DO was not significantly associated with persistent postoperative urgency/UUI. These findings should be considered hypothesis-generating and require confirmation in adequately powered prospective studies.