At least one in four U.S. women will develop pelvic organ prolapse, a condition in which internal organs, such as the bladder or uterus, drop from their normal position into the vaginal canal. This happens when pelvic muscles weaken because of childbirth, surgery or aging. Women with prolapse will often develop symptoms such as urinary incontinence, pain during sex, discomfort when sitting, pressure in their pelvic region or constipation.
In the May 15 issue of JAMA, Iglesia, a gynecologic surgeon, reviewed a study (published in the same issue of JAMA) involving a surgical procedure for prolapse called sacrocolpopexy. During this sacrocolpopexy trial, half of patients underwent an additional procedure to prevent urinary incontinence (urethropexy).
The study demonstrated that almost half of the procedures eventually fail within seven years, meaning organs had prolapsed again. However, fewer patients reported dissatisfaction and only five percent required repeat surgery over seven years of follow-up.
Iglesia says the study suggests “that long-term composite results are not optimal, but many women have relief of symptoms following surgery…”. Iglesia emphasizes the importance of weighing the objective measures of surgical success with the improvement women report in their quality of life.
“In this era of shared decision making, the next logical question is, ‘How do physicians advise patients who are contemplating pelvic reconstructive surgery for prolapse?’”
Adding to the challenges, Iglesia notes that rates of prolapse and incontinence surgery are expected to increase substantially over the next 40 years as the population ages.
“Patients need to have adequate, informed consent discussions about the available surgical and nonsurgical options for prolapse and incontinence, with an understanding of their expectations, [other] medical [disorders] and review of available data.”
Iglesia suggests that both surgeons and patients may need to “temper” their expectations and recognize that prolapse surgery will not last a lifetime.
“Ultimately, patient-reported outcomes of symptom relief are the most important and fundamental goals of [prolapse] surgery,” she concludes.
Iglesia, a board certified gynecologist, also is section director of female pelvic medicine and reconstructive surgery at MedStar Washington Hospital Center. She has served as a consultant for the U.S. Food and Drug Administration on a surgical mesh panel in September 2011.
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis – or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization (BGRO), which accounts for the majority of externally funded research at GUMC including a Clinical Translation and Science Award from the National Institutes of Health.