Pelvic organ prolapse surgery less effective than expected

Nearly one-third of women develop anatomic or symptomatic treatment failure within 5 years of undergoing sacrocolpopexy for pelvic organ prolapse (POP), according to a study published in the May 15, 2013, issue of the Journal of the American Medical Association.

The study, “Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse,” involved a long-term follow-up of the randomized, masked 2-year Colpopexy and Urinary Reduction Efforts (CARE) trial of women with stress incontinence who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and also received either concomitant Burch urethropexy or no urethropexy.

According to the study authors, more than 225,000 surgeries for POP are performed annually in the United States. Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about safety and long-term effectiveness.

"As our population ages, more and more women are going to be affected by pelvic organ prolapse, so it's critical to know whether these surgeries are effective," stated lead author Ingrid Nygaard, MD, a urogynecologist and pelvic reconstructive surgeon at the University of Utah, in a University of Utah press release.

Nygaard and her colleagues studied women who underwent sacrocolpopexy for a period of 7 years following surgery. The researchers found that nearly one-third of women experienced a recurrence of POP, either on examination or by reported symptoms, within 5 years of surgery.

"We were surprised to find that treatment failure rates after sacrocolpopexy were as high as they were," stated Nygaard. "But, it's important to note that the failure rate depends on how failure is defined. In our study, few women had repeat surgery, even if they had symptoms related to POP."

The researchers found that a majority of women who undergo sacrocolpopexy eventually experience urinary incontinence at some point, according to the University of Utah. Women who underwent urethropexy at the time of sacrocolpopexy were less likely to experience urinary incontinence and did not experience any additional complications related to that surgery. The researchers also found that mesh-related complications of sacrocolpopexy continue to occur over time. Approximately 10% of the women enrolled in the study experienced mesh erosion, and two-thirds of these women underwent surgical mesh removal.

"Women who undergo sacrocolpopexy need to be educated about symptoms, such as bleeding, discharge, or pain, which may be warning signs of mesh erosion, so they can seek help," Nygaard concluded, according to the University of Utah. "Our findings also highlight the importance of improving our understanding of the natural history of POP, as well as developing methods to prevent POP progression if diagnosed in its early stages."

Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-2024.