Symptom Recurrence Common After Surgery for Pelvic Organ Prolapse

Many women who undergo abdominal sacrocolpopexy for pelvic organ prolapse (POP) experience a recurrence of POP or urinary incontinence within 5 years of surgery, according to the findings of a long-term follow-up of the Colpopexy and Urinary Reduction Efforts (CARE) trial.¹
   
The initial CARE study involved 233 women who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and may or may not have also received Burch urethropexy. Of the 233 original participants, 215 women (92%) were enrolled in the extended CARE study, of which 181 (84%) completed 5 years of follow-up and 126 (59%) completed 7 years of follow-up. Approximately half of the participants also underwent Burch urethropexy to help prevent urinary incontinence, a common complication after POP surgery.
   
Each year, more than 225,000 surgeries are performed in the United States alone to correct pelvic organ prolapse. The gold standard of surgical treatments for pelvic organ prolapse is abdominal sacrocolpopexy, which involves the placement of mesh through an incision in the abdomen to hold the vagina in an anatomically correct position. However, it is unknown how effective this surgery is, especially over an extended period.
   
The results of this study showed that the estimated probability of treatment failure varied and was dependent on how failure was defined. After 7 years, the estimated probabilities of treatment failure in women in the urethropexy group and the no-urethropexy group were 27% and 22%, respectively, when defined as recurrence of anatomic POP; 29% and 24% when defined as recurrence of symptomatic POP; 48% and 34% when defined as recurrence of composite POP; 62% and 77% when defined as development of stress urinary incontinence; and 75% and 81% when defined as development of overall urinary incontinence. The probability of the complication of mesh erosion at 7 years was 10.5%. Despite these failure rates, very few women needed a repeat surgery even when they had a recurrence of symptoms related to POP.
   
“The direct cost of POP surgeries each year is over $1 billion,” said Ingrid Nygaard, MD, a urogynecologist and pelvic reconstructive surgeon at the University of Utah and first author of the study.² “Continued research will help both physicians and patients understand the potential benefits of and limitations of different surgical treatment options.”

Pertinent Points:
- The long-term success rates of a surgery to treat pelvic organ prolapse are lower than expected.
- Anatomic or symptomatic treatment failure develops in about one third of women within 5 years of undergoing sacrocolpopexy for pelvic organ prolapse.
 

References:

1. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016-2024.
2. New research shows pelvic organ prolapse surgery less effective than expected [press release]. Available at: http://healthcare.utah.edu/publicaffairs/news/current/05-14-2013_pelvic_organ_prolapse.html. Accessed May 20, 2013.