Ingrid Nygaard

Ingrid Nygaard

May 15, 2013 ~ Bloomberg (here) reports surgery to treat pelvic organ prolapse failed about 25 percent of the time within seven years.

Reported in the May 15th Journal of the American Medical Association (JAMA) this is the longest look ever to determine how those who undergo pelvic organ prolapse (POP) repair fared in the long-term.

Sacrocolpopexy, U of VA Health Services

Sacrocolpopexy, U of VA Health Services

In this case, the treatment involved abdominal sacrocolpopexy, abdominal surgery implanting a surgical mesh to correct POP, not transvaginal repair where a surgeon implants a mesh product through the vagina. Doctors generally agree there are fewer complications with an abdominal approach because the vagina is considered a “clean contaminated” field that may introduce bacteria into the mesh site.

About 225,000 women undergo surgery receiving the permanently implanted polypropylene mesh to hold up a uterus, vagina, rectum or bladder and urethra. Abdominal sacralcolpopexy is considered the most durable surgery but little was known about long-term effectiveness and how additional incontinence surgery using stitches only (Burch urethropexy) would affected the long-term outcome.

Women enrolled in the CARE study (215) had the abdominal sacrocolpopexy procedure between 2002 and 2005. Half had abdominal sacrocolpopexy and the Burch procedure and 111 had the sacrocolpopexy alone.

The results showed the surgery failed to secure the organs one-quarter of the time. Within seven years the prolapsed organs – uterus, vaginal wall or rectum prolapsed through the vagina for 48 percent of women, considered a symptomatic as well as anatomic failure.

Mesh erosion was a problem as well in about 10.5 percent of the patients at seven years.  For 81 percent, there was a return of incontinence among those who did not have a second procedure. For women who did have a second procedure, incontinence returned in 75 percent of the women. The quality-of-life issue of pain did not seem to be among the criteria judged.

“The surgery that is considered to be the most durable and effective for pelvic organ prolapse fails to restore normal anatomy in one out of four women,” said researcher Ingrid Nygaard to Bloomberg. She is a professor of obstetrics and gynecology at the University of Utah School of Medicine.

The study concluded that most women had improved health immediately following surgery but the “fix” is a temporary one. There is no information on how women fared outside of the seven years but the rates of failure increased during the duration of the trial.

Most women are told synthetic surgical mesh is the “gold standard” however this study finds it is not the miracle cure that is promised and the risks may not be worth the benefits.

More on Ingrid Nygaard:

http://healthcare.utah.edu/fad/mddetail.php?physicianID=u0513310

Here is a press release on the study:

http://www.eurekalert.org/pub_releases/2013-05/tjnj-sel050913.php

JAMA study:

http://media.jamanetwork.com/news-item/study-evaluates-long-term-effectiveness-of-surgery-for-pelvic-organ-prolapse/