Sacrocolpopexy success rates decline over time

May 20, 2013

Initial success rates of abdominal sacrocolpopexy for pelvic organ prolapse decline over the long term, according to a recently published multicenter study.

Initial success rates of abdominal sacrocolpopexy for pelvic organ prolapse decline over the long term, according to a recently published multicenter study.

The goal of the study, which was published in JAMA (2013; 309:2016-24), was to compare the long-term anatomic and symptomatic success rates in women undergoing abdominal sacrocolpopexy up to 7 years following the procedure and whether these factors were affected by concomitant Burch urethropexy for stress incontinence.

The authors found that anatomic support failure rates increased over time, and mesh erosion occurred in 10.5% of patients by 7 years. The results also revealed that concomitant Burch urethropexy decreased but did not completely eliminate subsequent urinary incontinence.

Most women (95%) in the study did not seek retreatment for prolapse once they experienced loss of vaginal support in the 7 years following abdominal sacrocolpopexy. The researchers reported that women may have found the initial treatment adequate, because abdominal sacrocolpopexy generally provides relief of pelvic organ prolapse symptoms, such as pelvic pressure or a bulge, despite progressive loss of anatomic support.

“While these findings highlight the reality of the condition treated by this procedure, abdominal sacrocolpopexy may still be a good option for some women. Physicians also can use this information to better counsel patients based on individual needs,” said co-author Linda Brubaker, MD, MS, of Loyola University’s Stritch School of Medicine, Maywood, IL. “Fortunately, this procedure is now available with the minimally invasive approach. We also have vaginal reconstructive procedures that may be good alternatives for patients who do not choose to undergo a traditional abdominal sacrocolpopexy.”

“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,” added first author Ingrid Nygaard, MD, of the University of Utah, Salt Lake City. “Our findings also highlight the importance of improving our understanding of the natural history of pelvic organ prolapse, as well as developing methods to prevent pelvic organ prolapse progression if diagnosed in its early stages.”

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