Cara L Grimes1, Emily S Lukacz, Marie G Gantz, Lauren Klein Warren, Linda Brubaker, Halina M Zyczynski, Holly E Richter, J Eric Jelovsek, Geoffrey Cundiff, Paul Fine, Anthony G Visco, Min Zhang, Susan Meikle. 1. From the *Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; †Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, CA; ‡RTI International, Research Triangle Park, NC; §Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL; ∥Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; ¶Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; #Obstetrics, Gynecology, & Women's Health Institute, Cleveland Clinic, Cleveland, OH; **Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada; ††Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; ‡‡Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; §§Department of Biostatistics, University of Michigan, Ann Arbor, MI; and ∥∥The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Abstract
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.
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.
Authors: Ingrid Nygaard; Linda Brubaker; Halina M Zyczynski; Geoffrey Cundiff; Holly Richter; Marie Gantz; Paul Fine; Shawn Menefee; Beri Ridgeway; Anthony Visco; Lauren Klein Warren; Min Zhang; Susan Meikle Journal: JAMA Date: 2013-05-15 Impact factor: 56.272
Authors: Gary Sutkin; Halina M Zyczynski; Amaanti Sridhar; J Eric Jelovsek; Charles R Rardin; Donna Mazloomdoost; David D Rahn; John N Nguyen; Uduak U Andy; Isuzu Meyer; Marie G Gantz Journal: Am J Obstet Gynecol Date: 2019-08-23 Impact factor: 8.661
Authors: Cara L Grimes; Rosanna H Overholser; Ronghui Xu; Jasmine Tan-Kim; Charles W Nager; Keisha Y Dyer; Shawn A Menefee; Gouri B Diwadkar; Emily S Lukacz Journal: Int Urogynecol J Date: 2016-05-26 Impact factor: 2.894
Authors: Alicia Ballard; Candace Parker-Autry; Chee Paul Lin; Alayne D Markland; David R Ellington; Holly E Richter Journal: Int Urogynecol J Date: 2015-02-12 Impact factor: 2.894
Authors: Cristina B Geltzeiler; Elisa H Birnbaum; Matthew L Silviera; Matthew G Mutch; Joel Vetter; Paul E Wise; Steven R Hunt; Sean C Glasgow Journal: Int J Colorectal Dis Date: 2018-08-03 Impact factor: 2.571