Effect of vNOTES hysterectomy with uterosacral ligament suspension on overactive bladder symptoms in patients with pelvic organ prolapse: a retrospective cohort study.

BACKGROUND/AIM: To evaluate the anatomical and functional outcomes following vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy combined with bilateral uterosacral ligament suspension in patients with apical prolapse and concomitant overactive bladder symptoms. MATERIALS AND METHODS: This retrospective cohort study was conducted at a single tertiary referral center. Women with symptomatic apical prolapse (stage ≥ II) and concomitant overactive bladder symptoms were included. All patients underwent vNOTES hysterectomy with bilateral uterosacral ligament suspension. Anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system, whereas functional outcomes were evaluated using validated questionnaires, including the Pelvic Floor Distress Inventory-20 (PFDI-20), Overactive Bladder Questionnaire-V8 (OAB-V8), and Overactive Bladder Symptom Score (OABSS). RESULTS: A total of 25 patients were included in the study. Significant improvements were observed across all POP-Q system parameters at the 3-month postoperative follow-up. Furthermore, assessments of pelvic organ prolapse and overactive bladder symptoms using the PFDI-20, OAB-V8, and OABSS revealed statistically significant postoperative improvements compared with baseline. Overall, among all POP-Q measurements, only the change in point C was significantly associated with improvements in overactive bladder symptom scores measured by the OAB-V8 and OABSS (r = 0.642, p = 0.001; r = 0.589, p = 0.002, respectively). CONCLUSION: The vNOTES approach to bilateral uterosacral ligament suspension appears to be an effective minimally invasive technique that not only restores apical anatomical support but also substantially alleviates overactive bladder symptoms. Improvement in apical support may be a key determinant of functional recovery.