INTRODUCTION: Symptoms of overactive bladder (OAB) are reported following hysterectomy. However, this relationship when a hysterectomy is performed for prolapse repair, and the risks factors for development of such symptoms are not well understood. OBJECTIVE: This study seeks to assess the incidence of new OAB medication prescriptions after hysterectomy for prolapse repair and associated factors. METHODS: We conducted a retrospective analysis of deidentified private payor insurance claims data for services from October 2015 to 2024. The cohort consisted of individuals undergoing hysterectomy for prolapse, identified by ICD-10-CM and CPT codes. Additional prolapse procedures were categorized using CPT codes. The primary outcome was a new filled prescription for a medication used to treat OAB. A Cox proportional hazard model adjusting for patient and surgical attributes was used to assess factors associated with receipt of OAB medication prescriptions. We excluded those with an OAB medication prescription prior to surgery. RESULTS: We identified 6,915 patients who underwent hysterectomy for prolapse. The average age was 51.3. In this group, 4.75% (N=329) received at least one prescription for an OAB medication following their hysterectomy. The average time to a prescription was 537.5 days; however, 41.6% (N=137) received a prescription within 180 days. The model found performance of an incontinence procedure at time of initial prolapse repair was also associated with a subsequent OAB prescription (HR 2.0, 95% CI 1.6–2.5). COPD was also associated with an OAB prescription (HR 2.1, 95% CI 1.1–4.0). Those living in a non-metropolitan area had a lower likelihood of receiving an OAB prescription (HR 0.75, 95% CI 0.58–0.99). Concurrent abdominal pain and menstrual pain were both associated with increased likelihood of medication prescriptions (HR 1.5, 95% CI 1.12–1.9, and HR 1.27, 95% CI 1.02–1.58, respectively). Conversely, concurrent diagnosis of fibroids at time of hysterectomy was associated with lower likelihood of prescription (HR 0.8, 95% CI 0.64–0.99). Hysterectomy approach, type of concurrent prolapse procedure, age, and patient comorbidities were not associated with prescriptions. CONCLUSIONS: Prescriptions for OAB medications are relatively rare following prolapse surgery, with only a small percent of patients receiving a prescription within 180 days after surgery. Those with surgically treated incontinence are at higher risk, while there was no association with prolapse procedures performed or route of hysterectomy. Future studies can examine patient demographic factor differences in prescription patterns. Overall, these results suggest that correction of prolapse regardless of surgery performed has limited influence on development of OAB symptoms.
Latack et al. (Fri,) studied this question.