What happens to the posterior compartment and bowel symptoms after sacrocolpopexy? evaluation of 5-year outcomes from E-CARE.

Published

Journal Article

OBJECTIVES: The objective of this study was to describe posterior prolapse (pPOP) and obstructed defecation (OD) symptoms 5 years after open abdominal sacrocolpopexy (ASC). METHODS: We grouped the extended colpopexy and urinary reduction efforts trial participants with baseline and 5-year outcomes into 3 groups using baseline posterior Pelvic Organ Prolapse Quantification (POP-Q) points and concomitant posterior repair (PR) (no PR, Ap <0; no PR, Ap ≥0; and +PR). Posterior colporrhaphy, perineorrhaphy, or sacrocolpoperineopexy were included as PR, which was performed at surgeon's discretion. Outcomes were dichotomized into presence/absence of pPOP (Ap ≥0) and OD symptoms (≥2 on 1 or more questions about digital assistance, excessive straining, or incomplete evacuation). Composite failure was defined by both pPOP and OD symptoms or pPOP reoperation. RESULTS: Ninety participants completed baseline and 5-year outcomes or were retreated with mean follow-up of 7.1 ± 1.0 years. Of those with no PR (Ap <0), 2 women (2/36; 9%) developed new pPOP with OD symptoms; 1 underwent subsequent PR. Nearly all (23/24; 96%) with no PR (Ap ≥0) demonstrated sustained resolution of pPOP, and none underwent PR. Fourteen percent (4/29) of +PR underwent repeat PR within 5 years, and 12% had recurrent pPOP. Regardless of PR, OD symptoms improved in all groups after ASC, although OD symptoms were still present in 17% to 19% at 5 years. CONCLUSIONS: Symptomatic pPOP is common 5 years after ASC regardless of concomitant PR. Obstructed defecation symptoms may improve after ASC regardless of PR. Recurrent pPOP and/or reoperation was highest among those who received concomitant PR at ASC. Further studies identifying criteria for concomitant PR at the time of ASC are warranted.

Full Text

Duke Authors

Cited Authors

  • Grimes, CL; Lukacz, ES; Gantz, MG; Warren, LK; Brubaker, L; Zyczynski, HM; Richter, HE; Jelovsek, JE; Cundiff, G; Fine, P; Visco, AG; Zhang, M; Meikle, S; NICHD Pelvic Floor Disorders Network,

Published Date

  • September 2014

Published In

Volume / Issue

  • 20 / 5

Start / End Page

  • 261 - 266

PubMed ID

  • 25181375

Pubmed Central ID

  • 25181375

Electronic International Standard Serial Number (EISSN)

  • 2154-4212

Digital Object Identifier (DOI)

  • 10.1097/SPV.0000000000000085

Language

  • eng

Conference Location

  • United States