Though most prolapse surgeries regress over time, symptoms remain improved

April 17, 2018

DURHAM, N.C. - An estimated one in three women in the U.S. has a pelvic floor disorder, a condition that often develops after bearing children and getting older. These disorders can lead to incontinence, painful intercourse and even the bulging or prolapse of pelvic organs into the vaginal canal.

Surgeons have been performing procedures to improve these symptoms for decades, but few studies have tracked how patients fared beyond the first couple of years after surgery. A Duke-led study publishing April 17 in the Journal of the American Medical Association followed women for five years after two common prolapse surgeries and found failure rates for both procedures were equally high, at over 60 percent.

However, surveys of the nearly 300 women in the study found that even for patients whose surgical adjustments regressed or caused new or worsening symptoms, more than half still reported that their quality of life five years later was much better than before surgery, and relatively few women sought retreatment.

"This was surprising to us," said lead author J. Eric Jelovsek, M.D., director of Data Science for Women's Health in Obstetrics and Gynecology at Duke. "That failure rate was higher than we expected. But that does not necessarily align with how patients feel, and we don't know why that is. It is possible the definitions we set for failure in this case were too stringent. We need to do some more research to understand what is the most optimal way to define success or failure, and how that factors in women's quality of life and desire to seek retreatment."

The randomized clinical trial, known by the acronym OPTIMAL, began in 2010 as an initiative of the National Institute of Child Health and Human Development (NICHD) Pelvic Floor Disorders Network. The mission was to compare two common treatments for prolapse -- sacrospinous ligament fixation (SSLF), resulting in a 70.3 percent failure at 5 years, and ligament vaginal vault suspension (ULS), resulting in a 61.5 percent failure at 5 years. Participants' median age was 57 years.

For both operations, surgeons access the affected area through the vagina, bringing points of the tissue upward to connect with ligaments on the pelvis. The goal is to reattach the woman's own tissue to support pelvic organs and reduce incontinence. No synthetic mesh is used in either procedure.

If after five years, the repaired tissue descended past the upper third of the vaginal canal, researchers considered the surgery a failure. The procedure was also considered failed if the patient felt a bothersome bulge or sensation of prolapse, or were treated again with surgery or a removable pessary to relieve their symptoms. About 12 percent of ULS patients and 8 percent of SSLF patients were treated again with one of these options.

The trial also evaluated whether several weeks of behavioral therapy and pelvic muscle floor training could improve success rates for either procedure, but there was no significant difference in outcomes.

The results suggest that neither procedure might work as well in the long-term as surgeons once thought, Jelovsek said.

"We may be at the point where we need to think of treating prolapse as treating a chronic disease that's likely to return over time" Jelovsek said. "It's like getting a hip or knee replaced. Will your quality of life improve? Yes. Is it worth it? Absolutely, but down the road this will likely be something we'll have to revisit."

However, he said, "These are still very reasonable surgical options to regain quality of life. The surgical improvements to the anatomy might gradually regress, but the relief is significant enough that after five years, more than half of the women report their symptoms were still improved."
-end-
In addition to Jelovsek, study authors included Matthew D. Barber, Linda Brubaker, Peggy Norton, Marie Gantz, Holly E. Richter, Alison Weidner, Shawn Menefee, Joseph Schaffer, Norma Pugh, and Susan Meikle.

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women's Health (U01 HD041249, U10 HD041250, U10 499 HD041261, U10 HD041267, U10 HD054136, U10 HD054214, U10 HD054215, U01 HD069031, and 500 U10 HD054241).

Duke University Medical Center

Related Surgery Articles from Brightsurf:

Decision conflict before cancer surgery correlates with lower activity after surgery
Nearly one-third of cancer patients who decide to undergo surgery for their condition may have second thoughts, and this decision conflict may lead to less favorable treatment outcomes in both the near- and long-term, according to a team of investigators at Massachusetts General Hospital and Ariadne Labs.

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.

Guidelines for thyroid surgery published in Annals of Surgery
The first set of comprehensive, evidence-based clinical guidelines for surgical treatment of thyroid disease -- developed by an expert panel assembled by the American Association of Endocrine Surgeons (AAES) -- was published today by Annals of Surgery.

Colorectal surgery patients use fewer opioids, report less pain with enhanced recovery after surgery
Colorectal surgery patients who were a part of an enhanced recovery after surgery (ERAS) program had less pain, while using nearly half as many opioids, according to research being presented at the ANESTHESIOLOGY® 2019 annual meeting.

Video assisted lung surgery reduces complications and hospital stays compared to open surgery
Video-assisted thoracic surgery is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according to research presented today the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

Most deaths related to noncardiac surgery occur after surgery and after discharge from hospital
It's not the operating room that is risky for patients undergoing noncardiac surgery; it's the recovery period.

Study looks at opioid use after knee surgery
A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.

Surgery patients are getting older every year
A new BJS (British Journal of Surgery) analysis reveals that people undergoing surgery in England are getting older at a faster rate than the general population.

Children requiring thyroid surgery have better outcomes at high-volume surgery centers
New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume.

Do negative public attitudes toward weight loss surgery stop some patients from having surgery?
Most patients who qualify for weight loss surgery don't have the procedure despite its safety and effectiveness.

Read More: Surgery News and Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.