POP surgery benefits may be short-lived
medwireNews: Pelvic organ prolapse (POP) surgery is beneficial but around a third of women will experience relapse within 7 years of their operation, show extended results from the Colpopexy and Urinary Reduction Efforts (CARE) trial.
"Based on our results, women considering abdominal sacrocolpopexy should be counseled that this procedure effectively provides relief from POP symptoms; however, the anatomic support deteriorates over time," write Ingrid Nygaard (University of Utah, Salt Lake City, USA) and co-authors in JAMA.
They say that patients should be informed that stress urinary incontinence (SUI) is common even with the addition of an anti-incontinence procedure and that women should be encouraged to report signs of mesh erosion, such as vaginal bleeding or pain.
In all, 215 participants of the original 2-year CARE trial for stress incontinence were followed up for a median of 7 years, including 111 patients who were randomly assigned to undergo abdominal sacrocolpopexy alone and 104 patients assigned to receive abdominal sacrocolpopexy plus Burch urethropexy.
The rate of POP anatomic failure - defined as the need for reoperation or pessary due to prolapse - and POP symptomatic failure - defined as a positive response on the POP
Distress Inventory, reoperation, or pessary - significantly increased over the study period.
By year 7, the estimated probability of anatomic POP failure in the sacrocolpopexy and sacrocolpopexy plus urethropexy groups was 0.22 and 0.27, respectively, with corresponding values of 0.24 and 0.29 for symptomatic POP failure, and 0.34 and 0.48 for the combined measures.
The estimated probability of SUI failure - defined as one or more symptoms on the Pelvic Floor Distress Inventory, additional incontinence surgery, or use of an urethral bulking agent - significantly differed between the single and joint surgical groups, at 0.77 and 0.62, respectively.
Moreover, urethropexy was associated with a significantly longer time to SUI symptom return, at 131.3 versus 40.2 months.
The researchers note that only 15 of the 31 women with anatomic POP failure reported symptoms and underwent surgery, as did just 22 of the 49 patients with symptomatic POP.
"The low reoperation rate for POP may imply that women found the treatment adequate; however, for older women, other health and social concerns may assume primacy over vaginal bulge symptoms," they suggest.
Noting that erosion from exposed suture or mesh in the vagina or surrounding tissue was reported in around 10% of patients by the last known follow up, Nygaard et al add: "We anticipate that continued research in mesh development will lead to new materials and applications with fewer adverse events, but our data highlight the importance of careful long-term evaluation of new devices."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lynda Williams, Senior medwireNews Reporter