Urinary incontinence burden and phenotype transitions after colpocleisis in older women with advanced pelvic organ prolapse

OBJECTIVE: This study characterizes urinary incontinence (UI) burden and symptom-based UI phenotype transitions 1 year after colpocleisis in older women with advanced pelvic organ prolapse. METHODS: This single-center retrospective cohort included women aged 60 years or older undergoing colpocleisis for advanced or recurrent pelvic organ prolapse between August 2019 and May 2025. Paired analyses included women with 1-year urinary follow-up. UI burden was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and symptom-based phenotypes were classified as stress UI (SUI), urgency UI (UUI), or mixed UI (MUI). RESULTS: Of 505 women, 495 completed 1-year follow-up; 258 had preoperative UI. Any UI decreased from 52.1% to 39.8% (paired absolute risk difference -12.3 percentage points, 95% confidence interval [CI] -17.8 to -6.7; P < 0.001). The median ICIQ-SF total score declined from 4.0 (interquartile range [IQR] 0.0-7.0) to 0.0 (IQR 0.0-5.0), with a Hodges-Lehmann paired estimate of -0.5 (95% CI -1.5 to 0.0; P < 0.001). UUI and MUI decreased, whereas SUI increased modestly. Among 237 women without preoperative UI, 65 (27.4%) developed de novo UI, of which 55.4% was slight and none was very severe. Baseline UUI most often transitioned to no UI, whereas baseline MUI showed the broadest postoperative distribution. CONCLUSION: Colpocleisis was associated with reduced UI burden and distinct symptom-based phenotype transitions at 1 year. Descriptive transition patterns might inform preoperative counseling but should not be interpreted as an individual prediction tool.