Overactive bladder de novo after sling surgery for urinary incontinence in women

Introduction. Overactive bladder (OAB) de novo, while not considered a life-threatening condition, can be a significant issue for the patient. Moreover, urge urinary incontinence is more difficult to manage than stress urinary incontinence (SUI). Even in the absence of incontinence, this condition can significantly reduce the quality of life and satisfaction with the intervention.

Objective. To summarise the existing data on OAB de novo after midurethral loop implantation (MULI) and to analyse the risk factors for the development of this condition and the existing options for correction, with an assessment of the prospects for further clinical trials.

Materials & methods. The search for publications was performed on national and international abstract databases eLibrary.Ru, Pubmed, Cochrane Library. The following keywords were used for the search: ‘de novo hyperactivity’, ‘de novo urgency’, ‘de novo OAB’, ‘midurethral sling complications’, ‘hyperactivity after sling implantation’. A chronological limit of 20 years (2004-2024) was used. A total of 317 sources (publications from peer-reviewed periodicals) were retrieved. 234 publications were excluded after reading the abstract because they did not fit the assigned topic. For further analysis, 24 papers were selected from the remaining works that met the criteria of scientific reliability.

Results. According to the world literature, OAB de novo appears in 6.4% to 11.5% of patients who underwent MULI. However, there are studies where the above condition was observed in 41% of cases at 20-year follow-up. The underlying causes of involuntary bladder contractions may include various neurological diseases, inflammatory process, decreased activity of pelvic floor muscle tone inhibitors, increased neurotransmitter release, increased sensitivity to neurotransmitters, increased afferent innervation and infravesical obstruction. The mechanism for the development of OAB de novo remains an ongoing challenge.

Conclusion. Any surgical intervention to correct SUI may lead to adverse effects, in particular OAB de novo. Information on the prevalence of this condition, as well as on approaches to its treatment, varies from study to study. There is a high percentage of underestimation of urgency symptoms at the preoperative stage. Therefore, a more detailed history should be taken and targeted investigations should be carried out at the initial consultation. OAB de novo following MULI significantly reduces patients' quality of life and satisfaction with the treatment.

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