The authors undertook a selective literature search and described, among others, medication therapy in urinary incontinence and aspects of surgical therapy in pelvic organ prolapse (1). Unfortunately they did not mention that symptoms of an overactive bladder—such as frequent urination, urinary urge, urge incontinence, and nocturia—are common in women with vaginal prolapse and can at high percentage rates be substantially corrected by undertaking axially aligned surgery on the responsible prolapse (2). Women with 2nd degree cystocele or rectocele have symptoms similarly as often as women with a 3rd-4th degree prolapse, and their condition is improved at similarly high rates by adequate prolapse correction (2).
Desmopressin is recommended for the treatment of nocturia—in older women too—without pointing out to readers that nocturnal polyuria in nocturia is confirmed in about 32% of cases and that, in addition to rare endocrinologic causes, heart failure or sleep apnea—among others—can lead to nocturia. The authors did not mention either that in women with vaginal prolapse and nocturia, surgical treatment for prolapse can substantially improve nocturia in up to 90% (3).
The pathophysiology of the development of urinary urge symptoms in vaginal prolapse has been known for a long time: the premature activation of the micturition reflex in the context of laxity of the anterior vaginal wall (2, 3). Urinary urge can also be a coexisting symptom in women with bladder voiding disorders and vaginal prolapse, and prolapse correction will treat both symptoms (4). Medication in women with symptoms of an overactive bladder can bring about serious adverse events, especially in older women. On the other hand, these women can choose potentially curative therapeutic options if they so wish.
Footnotes
Conflict of interest statement
The authors declare that no conflict of interest exists.
References
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